Why Medical Spas Fail Reason #7: Lack of Systems in Your Practice

In the book, “The E-Myth Physician”, Michael Gerber teaches us that unless your practice can be duplicated, it will never run without you.  According to Gerber, if you don’t have systems, then your aesthetic business will ultimately fail because you as the owner must keep all of the plates spinning in order to keep everything functioning.  Unless you train your employees to operate your clinic without you always having to be looking over their shoulder, you and your business will suffer from burn-out.  Systems and procedures are necessary for the long-term success of any business.

Perhaps the hardest area for doctors to address in their aesthetic practices is daily operations.  In each practice there are hundreds of daily routines and processes that take place. These processes are the methods in which things get done by our team members (support staff, laser technicians and consultants). This includes how the phone is answered, how consultations are scheduled, who is responsible for what services, how payments are collected, what paperwork clients fill out, how clients are greeted when entering the office, how clients are placed into the treatment room, how aesthetic treatments are performed, how consultations are conducted and measured, how charts are pulled and organized, and who is ultimately responsible for what.

Each of these areas can have a significant effect on the experience a patient has in your clinic and the profitability of your practice.  The importance of these areas should not be under -estimated.  If you find yourself working longer hours, getting paid less, feeling less in control and not having fun, then you need to develop an E-Myth practice.

Below is a list of the areas that should be systemized within your aesthetic practice:

Operational Procedures A. Pre-Opening Procedures Business Opening Checklist & Timeline Establishment of Business Guidelines Securing a Location Building Out Your Site Setting Up Bank Accounts Getting Insurance Meeting Your Tax Obligations Required List of Equipment Initial Inventory Conducting a Grand Opening B. Human Resources EEOC Guidelines Laws Regarding Harassment Immigration Reform Act Wage & Labor Laws Job Descriptions Employee Profile Recruitment The Employment Application The Interview Process Introductory Period Developing Personnel Policies Employee Orientation Training Time Reporting Compensating Staff Uniform / Dress Code Performance Evaluations C. Office Procedures Suggested Office Hours Customer Service Client Retention Daily Activities Confirming Appointments Checking Out First Time Clients Checking Out Regular Clients Accepting Payment Processing Auto Debit Payments Merchandising Retail Products Inventory Management Generating Business Reports Maintaining the Office Safety and Security D. Sales Scheduling New Client Appointments Established Client Appointments Greeting Clients Conducting Consultations D. Clinical Procedures Clinical Certification Treatment Programs Greeting Regular Clients Taking Clinical Photographs Clinical Chart Documentation Clinical Follow Up Calls Laser Safety Clinical Equipment Maintenance F. Advertising Calculating Advertising ROI Internal Advertising Strategies External Advertising Strategies Required Advertising Expenditures Public Relations Community Involvement Obtaining Advertising Approval

Written Medical Treatment Protocols Step by Step Clinical Treatment Protocols & Procedures Laser Hair Reduction NdYAG 1064 Photo Facial Fractional Resurfacing Spot Testing Set-up & Operation of Soprano Set-up & Operation of IPL Care & Maintenance of Lasers Infection Control Exclusionary List ST Handpiece Eye Protection Laser Safety Precautions Laser Committe Q Switch Laser eyewear inspections LSO Responsibilities Laser Safety Index Sclerotherapy Restylane and Juvederm Levulan Jessner Peel Botox Cosmelan DermaSweep Tooth Whitening Other Tx Index Accent Portrait PSR 3 Home Care Instructions Thermage Fractional Photofacial Portrait Hair Removal Restylane and Juvederm Jessner Peel Tattoo Removal Microderm Botox Cosmelan Levulan Laser Vein Accent Home Care Lipolysis Sclerotherapy Teeth Whitening Consent Forms Arbitration Agreement Thermage Fractional Photofacial Portrait Hair Removal Restylane and Juvederm Jessner Peel Tattoo Removal Microderm Botox Cosmelan Levulan Laser Vein Accent Home Care Lipolysis Sclerotherapy Tooth Whitening Medspa Build Out Design Full Color Floor Plan Interior Elevations Storefront Elevation Interior Finish & Color Board Interior Finish Schedule Interior Finish Listing Door & Frame Schedule Glass & Glazing Products Storefront Sign Panel Lighting Fixture & Ceiling Information Retail Display Elevations Furniture Information & Prices Cost Reduction Options Vendor List

Clinical Chart Documentation Chart Organization Guide Master Chart Checklist History & Physical Exam Sclerotherapy Progress Notes Microderm & Peels Progress Laser Hair Progress Notes Cosmetic Filler Progress Notes Tattoo Removal Progress Notes IPLProgress Notes Portrait Follow-Up logs Technician Daily Checklist Fillers Flowsheet Body Contouring Analysis Hair Removal Flowsheet IPL Flowsheet Nd Yag Flowsheet Accent Flowsheet Fractional Flowsheet Client Intake Profile Portrait Treatment Log Tattoo Removal Progress Notes Administrative & Employee Forms Spreadsheet Cashflow ProForma Automatic Payment Form Package Treatment Plan Treatment by Treatment Plan Master Price Book Front Desk Operations Front Desk Certification Manual Refund Policy Opening Receptionist Checklist Closing Receptionist Checklist Employee Forms Uniform Specifications Employee Evaluation Employee Warning Notice Employee Status Change Form Reference Check Interview Report Interview Questions Application for Employment Office Policy Manual Orientation Checklist Form I-9 Time Sheet Vacation Request Corrective At Will Action Notice Employee Policies Handbook Employee Accident Report Medspa Business Plan Executive Summary Strategic Objectives Mission Statement Products and Services Clinics in Operation Consolidated Profit/Loss Market Analysis Summary Market Segmentation Buying Patterns Competition Competitive Advantages Physician Recruitment Staff Recruitment Staff Training Marketing Strategy Sales Strategy Implementation Strategy Management Team Liability Protection Funding Request & Overview 36 Month Pro Forma P&L 36 Month Expansion Pro Forma Corporate Support Expenses Cash Flow Per Clinic Per Clinic Start Up Cost This business plan successfully funded the build out of multliple aesthetic practices. It can also give your existing practice new ideas on how to improve and enhance your operational performance.

Automate your systems, get better results. Check out the Ultimate Clinic Operations Blueprint and find out more.

Why Medical Spas Fail Reason #6: Poor Liability Protection

Liability protection is not just about properly medical malpractice coverage, it’s about several layers of protection within your aesthetic practice that help to insulate you from the potential you will be sued.  While you can never completely protect yourself from lawsuits, the following areas can serve as extra layers of protection:

1) Newer, Safer Equipment.  The newer equipment on the market has become more user-friendly and safer to use.  Using older technology can be much more “expertise” driven and in the wrong hands, can have disastrous results.  Some of the problems with older technology is inadequate cooling on the skin, a lack of ongoing calibration and maintenance of the older equipment, and a poor user-friendly interface that helps ensure the operator provides a safe treatment.  While newer equipment can never replace someone who has been properly trained in the safe user of lasers, it goes a long way to help prevent adverse reactions from occurring in the first place.

2) A Very Client-Friendly Practice.  It is important that your practice develops client friendly procedures within your practice.  Some of these include:  all clients who have received a procedure should receive a follow up clinical telephone call the day after treatment to make sure they are responding well to treatment.   Research has shown that most malpractice problems arise when patients feel they have no other recourse but to sue.   You should encourage your customers to contact you if they are dissatisified for any reason.   If they have any concerns regarding their treatment, you want to hear from them.  Doctors are required to be accessible telephone if they need to contact any client who is concerned for any reason.

3) Consent Forms Signed by Each Client.  Prior to receiving any treatment at your clinic, your clients should be required to read and sign an informed consent form that explains the risks associated with the treatment they are undergoing.  Typical risks include blistering, hyperpigmentation, and hypopigmentation.   In the event any of these adverse events happen to any client, you have signed a consent form that documents the client was aware of the risks prior to undergoing treatment.  If legal action is taken, you will have the consent form as proof that the client was aware of the risks of treatment.  Adverse events are very rare, however, and typically resolve over time so there is no lasting negative effect.  If no permanent damage remains, then there is no case for legal action.

4) Using FDA Approved Devices and Cosmetic Substances.  It is important to use only FDA approved devices and substances.  If anything were to go wrong during the treatment, the fact that a client was given an FDA approved treatment limits your clinic’s liability dramatically.  As long as you follow the guidelines for use with those FDA approved substances and devices, you are on very safe ground.

5) The Issue of Permanent Damage.  In order for a malpractice suit to hold up in court, there must be evidence of permanent damage.  In virtually every case with non-invasive cosmetic procedures, any damage caused to the client is typically temporary.  A good example would be hyperpigmentation.  In every case, hyperpigmentation will go away, leaving NO causation for someone to sue the center.

6)  Onsite Physician Providers.  The vast majority of reported lawsuits stemming from cosmetic procedures have been performed by poorly trained non-physicians who did not receive adequate physician supervision.  Having an on-site physician who has been trained and certified to perform and supervise all clinical procedures allows you to bypass a lot of the potential pitfalls of a standard “Medspa”

7) Arbitration Agreement Signed by Each Patient.  A signed arbitration agreement should be required of every client prior that undergoes any treatment offered at your clinic.  The arbitration agreement requires that any dispute that arises between a client and your practice will be determined by submission to arbitration as provided by state law and not by a lawsuit.  Both parties give up their constitutional rights to have any dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.

8)  Professional Liability Insurance.  The final layer of protection is professional liability insurance.  You want to make sure you have a policy that covers both the physician and all individuals who are performing any aesthetic treatment under the doctor’s supervision.  The good news is there are now many insurance programs available for aesthetic practices and the price for coverage is very competitively priced.

Why Medical Spas Fail Reason #5: No Physician Ownership

If you don’t have a doctor involved in your medspa, this could be the kiss of death to your business.

A major key to success for aesthetic practices who have weathered the recession has been the use of doctor-owners who provide high-end treatments and oversee the care delivered at each clinic.  Doctors should be viewed as profit centers who provide a substantial amount of the high-end services offered at each clinic.  This allows you to provide treatments that many competitors cannot at their facilities such as CO2 Fractional Skin Resurfacing, Laser Lipolysis, Body Jet Body Contouring, Fat Grafting, Laser Tattoo Removal, and other physician-based treatments.

The use of doctor-owners also increases customer-confidence and is used as a strong selling point to customers as they build relationships of trust with the doctor and other staff members.  In the event of an adverse reaction or customer concern, the value of a dedicated, full time physician to address customers’ concerns cannot be underestimated.  The vast majority of reported lawsuits stemming from cosmetic procedures have been performed by poorly trained non-physicians who did not receive adequate physician supervision.

Why Medical Spas Fail Reason #4: Poor Aesthetic Consultations

If you are like most aesthetic practices, you will be spending a considerable amount of money on advertising to try to get people through your doors.  As we have already discussed, you need to make sure you are spending your advertising effectively and that your receptionist is skillful in getting a consultation booked.  The next critical step is to conduct a quality consultation and that your client moves forward with treatment and pays you money.

You are doing our clients a HUGE disservice if you do not give them a thorough, quality consultation.  In addition, the quality of your services is judged during the initial consultation.  If you perform a poor consult, how can people expect that you provide exceptional service or results?  This step is what separates you from other aesthetic practices and establishes your credibility as a skin care expert.  It can also be the difference between having a profitable practice and failing miserably.

Tracking Data and Holding Employees Accountable

Employees conducting consultations should be held accountable for their performance and be rewarded if they do well.  Every practice should track consultation closing percentages and the average dollar collected per consultation booked.  If you aren’t tracking this information, the old adage holds true, “If you don’t know where you’re going, any road will get you there.”  You should hold regular meetings with your consultants to review their performance and help them establish future goals for improving along with training in areas of weakness they may have demonstrated.

The Right Person with the Right Skills

A quality consultation establishes a strong relationship that can pay large dividends for many years to come and requires significant positive energy and work.  You can’t delegate this responsibility to just anyone in your practice.  You need to make sure the right person with the right people skills is performing this critical step and that you incentivize him or her appropriately.  This person must find great personal satisfaction in helping the client achieve her aesthetic goals.  They should also be motivated by money and you need to provide proper incentives to make sure they commit the appropriate amount of energy during the consultation.  Aesthetic consultations is a sales process, plain and simple and you need to hire good salespeople.  This shouldn’t come as a surprise to anyone.

What skills do top consultants possess?

• They have presence (energy, conviction, interest when speaking & listening)
• They are good at relating to other people
• They use good questions to uncover needs
• They understand what the customer communicates in words, tone, and body language
• They are good at customizing their products to the needs of the customer
• They ask follow up questions to make sure the customer understands what they are saying
• Understand and present the appropriate procedures with before/after benefits

Develop a Consultation Certification Program

To be a good consultant, you must become well-educated in the following areas:  skin anatomy, cosmetic skin diseases, current aesthetic treatments & technologies, light-based treatments (ablative & non – ablative), botox & cosmetic fillers, laser lipolysis, radio frequency technology (tightening, fat & cellulite), fractional skin resurfacing.  Even if you clinic does not perform all of these treatments, you need to be knowledgeable because chances are the client will be.  Most prospective clients have done their research in advance through the internet and if you’re not careful, they could very well have more knowledge than you.  If you aren’t knowledgeable in these areas, this will become very clear to the prospective client and will hurt your consultation performance.

There are plenty of good books out there that you can use as your curriculum and you can also have your staff develop quizzes and tests and hold regular meetings to get your entire staff knowledgeable regarding all of these areas.

Focus on High Dollar / High Margin Procedures

You have a limited time to spend with each client during a consultation.  You can easily spend one hour per consultation or more.  To maximize your time during these consultations, you need to make sure you understand your sources of greatest revenue.  You must focus on HIGH DOLLAR / HIGH MARGIN treatments.  Selling larger packages typically means combination therapy which results in happier clients.  It is important that you understand that your goal of increased revenue is aligned with the client wanting the best results possible Small packages or single treatments typically do not yield good results and the client walks away dissatisfied – never to return!!!

Do not pre-judge what the client wants, needs or how much she can spend.  Do not judge a book by its cover.  As a consultant, do not impose your project your value system onto the client.  Personally, I would rather spend $3,000 on a new HD TV, not on a package of facial rejuvenation treatments, however I am not the prospective client!  Give the client what her or she wants, not what you want.

Where to focus your energies

People are willing to spend big dollars to rejuvenate their face and sculpt their body.  Your skin analysis and consultations are designed to generate COMBO PACKAGES / HIGH DOLLAR SALES.  The amount of quality time you spend with clients is proportionate to the size of packages you sell them.  You want to spend at least one hour on facial consultations – if not more

Conduct a Quality Skin Analysis

Conducting a skin analysis is a critical step in the consultation process and it is how we get the client to open up regarding their perceived skin issues and problems.  There are many different types of equipment that’s out there that you can use as tools for the skin analysis. Some of the most simple yet effective tools are the following:  (1) a lighted mirror magnifier, (2) a Woods Lamp (3) a Video Skin Microscope.  We use these tools to help the client reveal to us what there most important skin issues are.  It is important to remember that the prospective client should be the one doing most of the talking while using these tools.  The client is ultimately the one “conducting” the skin analysis.  What are issues to you may not be issues to them.  You need to focus on their expressed issues!  After the skin analysis, we then determine the client’s hot buttons and help them prioritize their expressed issues.

Systemizing Your Consultation Process

Your chances to develop good consultants increase exponentially if you have developed a system to help your sales staff perform consultations.  In addition to a system for skin analysis, we have also developed other tools in our clinics to help our salespeople succeed.  We have developed PowerPoint presentations that the consultant can use to review how treatments work with the prospective client and show appropriate before and after photographs.  These presentations cover the same material every time and eliminate the variability of different expectations that can arise if each consultant is promising different results.  It is important to set the right expectations (number of treatments, potential side effects, good candidates for the procedure, etc.).  Having a system to present strengthens our expertise in the client’s eyes.

Closing the Sale

All of your work during the consultation is for nothing unless you can close the sale.  It is important that you close the sale with a timeline incentive that motivates the prospect to action.  If you don’t close them during the consultation, you only have a small chance (10-15%) of closing them later.  We typically give the client a free treatment if they commit to move forward on the day of their consultation.  It is important to place pressure on the client without it being a “hard sell” approach.

Another important approach is to give the client a choice between “YES” commitments.  An example of this would be:  You can pay for the entire package today and receive a $500 free treatment, or you can opt for the 6 month payment plan at $X per month, which option would work best for you?”

Items Needed for Consultations

We use the following tools for all of our consultations:  a Price Sheet, Client Profile Sheet, Skin Analysis Sheet, Suggested Treatment Plan, a Hand Calculator, Flat Screen TV or Projector, a computer to connect to TV or Projector, Consultation Power points, and Skin Analysis Equipment.

In summary, consultations require passion, energy, and intensity.  If any of your employees aren’t strong in these areas, they should not be performing consultations.  Consultations also require a systemized approach that ensures a certain level of consistency for each client who receives a consultation.  There is TOO MUCH at stake to leave consultations to chance or to someone who doesn’t care.

"Money is made in the consultation room, and lost in the operations." Learn more by amping up sales through consultations.

Why Medical Spas Fail Reason #3: Poor Telephone Conversion

First impressions mean a lot.  And because the telephone represents most people’s first impression of your aesthetic practice, it could mean everything–if they don’t love what they hear, they’ll hang up and keep calling around till they find someplace that they will love.  And if a caller is not interested in what they hear within the first 30 seconds, you’ve lost them for good!

You as the owner of the aesthetic practice have paid far too much in advertising dollars to hope your receptionist does a good job over the phone.  You can’t leave anything to chance, you could easily see all of your precious advertising money go right down the drain!  You need to convert a high percentage of prospective callers into scheduled consultation appointments.

How you answer the caller’s first question will set the tone for the rest of the conversation…and maybe the rest of the caller’s relationship with your aesthetic practice.   Most people who call in will ask you one or two questions either about the offer, the practitioner, prices, location, etc. They ask these questions because they don’t know you, and they don’t know what else to ask. These inquiries are the lifeblood of your aesthetic practice, and must be handled properly, using appropriate scripts.

Remember that your objective is to sell the appointment, not to sell a service over the phone. Try not to veer away from the script and get into a detailed discussion of your services.  What is important is to defer the caller while keeping their trust.  Tell the prospect, “The consultant will explain all of the details to you after she’s had a chance to meet with you.”  The following principles are essential to converting callers to scheduled appointments at your aesthetic practice.

Principal #1:  Your Receptionists Must Be Knowledgeable Regarding Your Services

How much does your receptionist know about the aesthetic services offered at your practice? If the answer is, “very little” then you need to make some radical changes in how you view your telephone help.  Whether for good or bad, callers expect your staff to be knowledgable about the services you offer.  Callers make a judgment on the quality of your services by the knowledge of your front desk staff.

If you have brochures on all of your treatments or if you have a website that explains your treatments, then you need to have your telephone receptionists study this information and TEST them on their knowledge of this information.  When someone asks them about how IPL works, they need to be able to provide a concise answer that addresses the question yet sets the stage for the caller to receive a scheduled consultation at your clinic.  I recommend that you establish weekly education meetings that require your staff to read material and take quizzes on the material.  You can get your staff involved by assigning a new staff member to develop the weekly quiz for the material you will be reviewing.

In addition to informational knowledge, there is no better way to help your receptionists become champions of your services but by receiving the treatments themselves.  This allows them to relate personal experiences of your treatments and help you pre-sell over the phone and book consultation appointments.

Principal #2  You Must Track and Record Your Telephone Calls.

You like your receptionists, but how do you know they are doing a good job?  Technology exists that allows you to record all incoming telephone calls into your practice and audit the responses your receptionists are giving to your prospective clients.  You can track your appointment conversion rates and assess how well your practice is doing in converting callers to appointments.  There are a number of services that allow you to audit your telephone calls, including:  WhosCalling[.]com.

Principal #3  You Must Incentivize Your Receptionists to Book Consultations

If you are converting at least 50% of all prospective callers into scheduled appointments, this is a good start, however it is only the beginning.  Your goal should be to continually improve your consultation booking percentage and reward your receptionists for doing a good job.  How do you incentivize your receptionists to book more consultations?  At our clinics one strategy that works very well is to pay your receptionist a base pay of $10-12 per hour and reward them for each new consultation they book during their shift.  This could be an incentive of $2 per consultation booked.  If the receptionist books 7 consultations during her shift, this results in an extra $14 they have made for the day and has increased their hourly pay from a base pay of $10 to $12 per hour to $12 to $14 per hour.

There are two caveats to this strategy:  (1) The Receptionist is in charge of tracking her own booked appointments in a log sheet if she wishes to be paid this bonus.  This makes your job of tracking a bit easier because the receptionist knows she must track the calls and report which consultations she booked for the day.  (2) In order for the receptionist to receive the $2 bonus per consultation booked, the booked consultation must actually show up for their appointment and receive a consultation.  This ensures the receptionist is setting up quality appointments and not just putting names on the schedule to receive extra pay.

Principle #4  The Receptionist Must Engage the Prospect. 

Help the prospect participate in the conversation.  When I consult with aesthetic practices, the biggest problem I see is the receptionist passively answering questions posed by the caller. When the caller is done with his / her questions, often times the receptionist doesn’t know what to do or say!  Nothing could be further from what MUST be done to keep your medspa running profitably.

The key to success in converting an incoming inquiry call into a booked appointment is to establish value and win their trust.  You accomplish this through your ability to ENGAGE the prospect right up front in the call.  Simply put, this means that you must help the prospect participate in the conversation so that they can feel comfortable asking their questions.

Listen Attentively.  The key to engaging the prospect is to listen attentively to them.  Be certain that you have heard what the prospect has said.  Restate their idea in your own words to be sure you have it right, and to let the other person know that you understand.  Make them feel comfortable asking questions.

Establish a relationship up-front.  If you answer the prospect’s questions directly, without engaging them in at least a brief conversation about their needs and concerns, they will still feel unsure or suspicious, and often will be reluctant to set an appointment.  That’s because you haven’t established a relationship with the prospect up front.

Be a good conversationalist.  When you “break the ice” and make them feel that they can trust you, they will feel much more comfortable about coming to see you.  Breaking the ice will enable you to set appointments a much higher percentage of the time.  Thus you must have a sincere interest in the people who are calling.  You must be a very good conversationalist while being sales-oriented in booking an appointment for the prospect.  And you must know about your aesthetic practice’s services, the practitioners and technicians and their backgrounds and certifications.

Ask open-ended questions.  They key to being a successful telephone call handler is to ask good, open-ended questions.   Open-ended questions are those that cannot be answered yes or no, and tend to lead to a long reply on the part of the prospect.  Examples include:

1. How long have you been considering this type of treatment?
2. How long have you had this problem?
3. When did you first notice the problem?
4. What type of cosmetic services are you interested in?
5. Does it seem to be getting worse?

Principle #5  Be Enthusiastic.

Be enthusiastic and caring in all that you say.  If it helps you to get the right attitude, think of the caller as a close friend who needs your help.

1. Smile when you talk.  If may sound trite, but smile when you talk – this actually helps you to transmit a positive “vocal transmission.”  Top converters smile when they speak.
2. Vary your tone and pitch.  Use the range of your voice to be louder, softer, faster, and slower – as it would sound naturally.  A monotone conversation will not sell anything.
3. Develop a Strong Belief in Your Aesthetic Practice’s Services.  People like to be convinced.  They want to hear how “wonderful” something is, and they hear that through your enthusiasm, your glowing reports, and your personal endorsements.  Become a user of your aesthetic practice’s treatments so that you can tell clients your own first-hand experiences.

After answering questions, schedule the appointment. After you’ve answered a question, assume the call is convinced, and go right into setting the appointment. If the caller has another question, he or she will ask, so you don’t need to say, “Do you have any more questions?” That will only make them think of one.

Principle #6  Be Prepared With Your Scripts.

• Be Ready to Talk When You Answer the Phone.    It’s more important to be comfortable and ready to talk with a caller when you answer the phone than it is to answer on the first ring.  Be sure you’re at your desk with your script in front of you.
• No one on hold for more than 30 seconds.  If you have too many calls to handle at once, and you have to put one (or several) on hold, make sure you come back at least once every 30 seconds to tell the caller that you’ll be right with them.  Studies show that after about 30 seconds on hold attention and interest falls dramatically.  If this is not possible, ask for their phone number so that you can call them back.
• Know the scripts given to you by your aesthetic practice.  Know the scripts, but put it in your own words so that it feels natural to you.  Keep the call conversational, like you’re talking to a friend.  Speak the words cheerfully, as if welcoming guests to a party you’re giving.
• Rehearse, rehearse, rehearse.  Go over the scenarios many times, both by yourself and by role-playing with someone else.  You may feel self-conscious at first, but that is exactly why you are rehearsing.  When the words become very natural to you, you are ready to take on real calls.
• Understand what you’re saying.  You must understand every single word and concept, otherwise it really will sound like you’re reading a script.  Discuss and define every term before you talk to anyone.

Principle #7  Show Empathy.

Mirror the prospect’s mannerisms.  This means matching their tone and pace.  If they speak slowly, you do the same.  If they speak at a fast pace, you speed up slightly.

• Try to ease their fears.  Remember that many people are a little intimidated when they have to call a new place.  Just like you, they want to make a good impression. So remember that they might already be uncomfortable so do what you can to ease their fears.
• Listen to the prospect’s concerns (emotional hot buttons) and give them what they need as a solution.  Never forget that you are talking to a real person.  Though you will hear the same questions, objections and concerns over and over, they are expressing them for the first time.  Each call must be considered an individual event, not just a piece of your day.  Each prospect you talk to must be treated as an individual as well.
• Show that you care about their concerns.  For instance, if the caller says, “I have to wait when I have an appointment” you can reply, “I know what you mean.   It makes me feel like my time doesn’t matter.”
• Learn the name of your caller and use that name frequently.  It’ll make him or her feel more comfortable.
• Listen carefully and empathetically to your caller, instead of just waiting until he or she stops speaking so that you can talk again.  Here’s a handy listening checklist:

1.      Think like the caller

2.      Don’t interrupt

3.      Listen for ideas, not words

4.      Interject occasionally, to indicate understanding of what the caller is saying

5.      Turn off personal worries

6.      React to ideas, not the person (you may not like the personality of the caller)

7.      Don’t’ jump to conclusions

Principal #8:  Follow a Basic Script

Below is a script we train our receptionists on and we expect them to study and become fluent in speaking.  By following this script it will dramatically increase your appointment conversion rate.  Please note the bold areas, these questions are critical.

Receptionist:  Thank you for calling (Practice Name), this is __________________ how may I help you?

Caller:  Yes, I’m calling about_________________________________.

If this is an established client, assist the client immediately with their question or need.  If this is a prospective client, proceed with the following dialogue:

Receptionist: That’s great!  Thank you for calling us.  I’ll be glad to answer that question for you.  May I ask your name first?

Prospect:  My name is:__________________.You get their name here so that you can use it to address them throughout the conversation.  This makes your conversation more personal.

Receptionist:  Thank you (prospect’s name). By the way, how did you hear about us?

Prospect:  From your (newspaper ad/ kiosk / passed by / other)

Receptionist:  (Prospect’ name), what was it that made you decide to call us?

Prospect:  (I’m tired of my wrinkles, I am tired of my unwanted facial hair, my friend spoke highly of you, etc.) – Draw them into additional conversation with this answer.

Receptionist:  Thanks for your help, (prospect’s name).  Okay, you wanted to find out more about (the reason for the prospect’s call) Example (laser hair removal price for the upper lip)  YOU NOW ANSWER THEIR QUESTION.

All calls lead to an appointment

We would be happy to get all of your questions answered about:_________, this normally begins with a free consultation at our center.    What day of the week is best for you?

Are mornings, afternoons or evenings best?

I’m not sure if that will work.  If you don’t mind, may I put you on hold?  I’ll see what arrangements I can make.

Thanks for holding.  It looks like I was able to squeeze you in on (Day) at (time).

In summary, having a strategy behind your telephone answering and training your staff well, you can dramatically increase your appointment conversion rates and your clinics profitability.  With no plan in place, you are leaving too much to chance and throwing precious dollars down the drain!

Step up your marketing game inside the clinic; set-up a waiting room video to convert to sales.

Why Medical Spas Fail Reason #2: Poor Advertising or Not Enough Advertising

Advertising is one of the biggest challenges facing an aesthetic practice because it is such a moving target.

There are so many variables that determine a successful advertising campaign.  In addition, what may generate a response at one point stops working eventually and you need to create a new strategy.  How do you know if you have “poor advertising?”  Where the “rubber hits the road” is your Return on Investment (ROI).  As a general rule of thumb, for every ONE dollar you spend, you NEED to get at least FOUR dollars back, if not more (a 4 to 1 ROI).  Why is this?  The key reason is that you STILL have all of your other overhead to cover.  If your advertising just pays for itself (a 1:1 ROI), then you will quickly be out of business.  Let’s use a simple example.  If I am investing $1,000 per month in Google Adwords, my expectation is to get at least $4,000 back in CASH revenue for my practice from that advertising expense (a 4:1 ROI).  If I just got $1,000 back (a 1:1 ROI), then all I’ve done is paid for the advertising and I still have all of my other overhead to cover (including those leases on equipment that I paid TOP DOLLAR for).

If you find an ad source is generating a 4:1 response, then you can often RAMP UP this advertising and generate more dollars.  What you begin to do is eliminate underperforming forms of advertising and invest MORE money in advertising strategies that are working. Whatever you’re advertising, you need to make sure you have enough margin built into the service you are advertising that it will be profitable.  You could sure advertise a special on $10 facials, however it may be difficult to make a good ROI on this type of service.  I always like to advertise the BIG GUNs services such as laser lipolysis, Thermage, Accent, etc.  These are services in which there is enough margin to make it worth your while and will help ensure a high ROI.

The greatest advice I have to give in this area is this:  YOU NEED TO COPIUSLY TRACK YOUR REFERRAL SOURCES.  Every call that comes in and every consultation that is booked needs to be assigned the correct referral source.  In our clinics, we require that when booking the consultation, a required field is to ask the caller how they heard about our clinic.  This referral source is fresh in the callers mind and it is now locked into the client’s information.  Our software program allows us to track how much revenue we generate by each referral source.  In this manner, it allows us to make intelligent decisions on advertising.  If advertising is not working (at least a 4:1 ROI), we pull the plug quickly.  Forget about “brand building” which is what the big boys do such as Coca Cola and Microsoft, we want and need DIRECT RESPONSE ADVERTISING to stay in business.  The key definition to direct response advertising is advertising that is designed to do one thing:  GET YOUR PHONE TO RING AND BRING MONEY THROUGH THE DOOR.

Not every prospective client calling your practice books an appoint, so there are now excellent ways to track EVERY referral source.  There are internet services available that allow you to assign individual telephone numbers, including toll free numbers to EVERY advertising piece you broadcast to your audience.  This allows you to capture key information such as:  (a) Total Calls Generated From Every Ad You Publish by day of the week, by the hour, and a myriad of other criteria.  In addition, since you know how much you are spending on your advertising, these services will also calculate your COST PER CALL.  As an example, if you are paying $1,000 per month for newspaper advertising and the total number of telephone calls you received from that ad source is 20 calls, then ($1,000 / 20 calls = $50 per call).  From my experience if you can get your cost per call below $50, then you are doing something right to get your telephone to ring.

What I also like about these services is you can actually record the telephone calls coming in to your practice.  How is your receptionist answering the phone?  How are her techniques?  Is she effectively booking 60 to 70% of prospective clients into booked appointments? Does she have an accurate grasp of the technology to answer basic questions?  Call tracking services such as these become INVAULABLE TO YOUR PRACTICE.  The reality is this.  You’re spending A LOT of money to get your phone to ring, you need to make sure you are capitalizing on this.

Since most practices don’t track their advertising, they are constantly shooting in the dark and trying new things without knowing what is truly working, except anecdotally.  One bad experience with a large outlay of advertising dollars without a lot of money in return can cause the doctor to retreat in fear and not do any advertising at all or very little advertising.  This becomes a downward spiral if you stop investing in advertising altogether.  It becomes a death sentence if you cease to invest in new leads for your practice.

External Advertising

External advertising represents advertising to people who are not currently your clients. Traditional forms of advertising have become less effective such as newspaper and the yellow pages.  Subscribership continues to fall away as is evident with several large newspapers going out of business.  When is the last time you used a yellow page phone book to find what you’re looking for?  The reality is the internet is completely replacing most of these traditional forms of advertising.

From my experience, you can save a lot of money by utilizing Internet Advertising.  There are several courses online that teach you how to do your own Google Adwords Advertising.  If you want to save significant money in the long run, you should develop this expertise in-house versus outsourcing this to an outside company.  In addition, many new internet mediums have exploded into the marketplace such as Facebook.  These new mediums have generated significant leads for the clinics I have associated with and are worth investigating.

Internal Advertising

Internal advertising represents advertising to your own client database. We all know that it costs a lot more to obtain a new client that to retain one.  If we assume you are providing the best possible service to retain your clients, the missing piece in most practices is developing a system to advertise to your own clients and keep them coming back.  If you have clients who love your clinic and your services, they welcome your offers and they want to hear from you! Continue to send them special offers available to “established clients” only to make them feel special.  Your ROI on your warm list of clients will be substantially higher than mailing to a “cold” list of people you are trying to obtain as new clients.  It is not unusual to receive a 10 to 1 ROI or higher with this group.

The amazing part of this, your advertising in this area doesn’t have to be expensive.  It can be a very simple letter or postcard or even telephone call.  Mailing out a simple letter that you mail-merge with your database personalizes your contact with the client and helps them feel unique.  You can promote new services and aesthetic devices you have recently acquired and offer “members only” pricing your database.  Emailing your clients is also good, but I have found my response rate drops off too dramatically to just rely on emails alone.  Emails should be coupled with a physical mailing such as a letter.

There are also services available that allow you to upload your list of clients to an online database.  You can then record a single telephone call and broadcast this single message to all of your clients!  It is an amazing tool that can really add a personal touch to your practice and leverage your time.  The doctor would record the call, thanking the client for their business and informing them of new services and offers available.  The message is only left on voice mail so the client doesn’t know it was a recording.  It is an exceptional service and I highly recommend it.  It ends up costing you approximatley 0.06 cents per phone number.

Get more patients with better advertising, find out how you can attract more patients in your practice or clinic.

Why Medical Spas Fail Reason #1: Paying Too Much for Equipment and Build-Out

Investing in an aesthetic practice can be very costly.

You can easily drop $700,000 to over a million to get your practice established.  Paying top dollar for new equipment allows peace of mind with warranty protection, but it comes at a very high cost.  While it is true that most used laser equipment is no longer under a manufacturer’s warranty, research has shown that you are almost ALWAYS better off buying used equipment and paying out of pocket for maintenance and repairs versus buying new and having it covered under warranty.  You are simply paying too high of a premium for the luxury of buying new.  If peace of mind is the issue, then buy a back-up piece of equipment at a 70% discount that you can rely on when your primary equipment goes down.  The reality is you will still be paying less than buying the brand new piece of equipment.

The key to this issue is to identify the companies who repair the used equipment you are considering to purchase.  Ask them to quote you prices on repairs and warranties if you have them.  Also make sure that parts are readily available for this equipment and that the equipment manufacture does not hold a monopoly on spare parts.  You need to do this footwork BEFORE you buy.  After you buy it can be too late and you may be taking too large of a risk.

You also need to find out which laser manufacturers are user-friendly to pre-owned equipment.  Some manufacturers can charge you a laser “RECERTIFICATION FEE.”  Recertification fees are sometimes required by the manufacture if the laser device is sold to someone else.  The laser manufactures claim it is to ensure the device has not been tampered with, however the real reason is to protect the manufacturer from being undersold by doctors looking to sell their used equipment.  Charging a “recertification fee” levels the playing field between the new and used price.  These fees can be as high as $25,000.

Sadly, most aesthetic equipment becomes obsolete 2 or 3 years after the initial purchase, however most leases on that same equipment last for 5 or 6 years.  In the world of aesthetics, technology is evolving at a rapid pace.  This evolution also means that technology does not remain useful for very long.  It’s a hard pill to swallow when you continue to make monthly lease payments on equipment that has become a “doorstop” inside your practice.  If you’ve paid top dollar for that equipment, it just makes that pill you’re swallowing even the more bitter.

Let’s use an example to illustrate this point.  If your practice buys a new Laser Gadget and your competitor buys the same Laser Gadget pre-owned at a 70% discount, your competitor has a large competitive advantage over you.  His fixed costs on capital equipment are 70% less than yours which means higher profit margins for him.  He also has the ability to offer lower treatment prices and potentially put you out of business.  You also have the option to match his lower prices, but you will need to compensate for the higher costs you are paying on that equipment by having a higher treatment volume.  If you choose to keep your prices higher, then you will need to somehow differentiate your practice from the competition by offering other “value-added” benefits that justify your higher prices.  This could be “Board Certified Dermatologist” or “Onsite Physician” etc.

If you feel strongly about buying new laser equipment versus used, do not accept the sticker price presented to you by your laser sales rep.  You must understand that everything is negotiable.  Do not accept a 1 year warranty, ask for a 3 year warranty.  If they are not negotiable on the price, then ask for a “DEMO” unit.  Demo is normally code word for a discounted price.  In most cases, demo units are not even used pieces of equipment, but it allows the manufacturer to legitimately sell you a new piece of equipment at a much lower price while maintaining their price integrity.

Regarding clinic build out, my recommendation is to find a medspa location that is already built out.  There are hundreds of medspas that have gone out of business.  In most cases they have ALREADY spent HUGE bucks to create a beautiful facility.  They have already spent the big bucks for tenant improvement.  You can pick these built-out locations for FREE.  Don’t invest this money yourself.  Find a realtor in your city who specializes in renting medical office space along with retail space.  He should have a good lay of the land on what is available.  You will be surprised with what gem locations are available.

Save up on equipment costs, and check out our selection of used cosmetic lasers over here.

Niche Yourself & Your Medical Spa

If you're not comfortable with creating or finding a niche that your medical spa can dominate... get familiar with it.

Guy Kawasaki is a well known speaker on technology, venture capital and startups. I've seen him give this presentation a number of times and this is dead-on accurate for any business, including your laser clinic or medspa.

If you're just copying everyone and trying to feed on the edges of the marketplace, your medical spa's just an also ran and you'll never experience the ability to control your prices or your income and you'll always be playing second fiddle to those clinics and physicians who understand these principals.

Average Salary For Physicians

Here's what the U.S. Bureau of Labor Services (BLS) report as the average salary of a physician in the US.

In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738."

Let's look at a few specific specialties, in ascending order:

General Pediatricians $161,410
Psychiatrists $163,660
Family and General Practitioners $168,550
General Internists $183,990
Obstetricians and Gynecologists $204,470
Anesthesiologists $211,750
Surgeons $219,770

Physicians and Surgeons, All Other $173,860.

Oh, and nursing jobs are going to grow over the next decade.

The number of registered nurses is expected to swell to 3.2 million by 2018, accounting for approximately 581,500 new jobs, according to the Bureau of Labor Statistics. That's up from 2.6 million today, and it represents the largest overall growth projection out of all occupations in the U.S. economy, for good reason.

Americans aged 65 and older will make up 19% of the population in 2030, up from 12.4% in 2000. As the population ages and the growth of the working-age population slows down, there will be an increased demand for health care services in general, and home health care services in particular. In the past year, the home health care services industry has experienced sales growth of 11.2%, making it the fastest growing industry in the U.S., according to Sageworks, a financial analysis company.

Along with registered nurses, Sageworks projects that home care aids, physician assistants, pharmacists, and other medical professions will be in high demand for the foreseeable future.

Race & Empathy In Medical Centers

Can race (or any difference) affect the quality of care that a patient receives at any medical center?

from CNN

In the study, which appears in the journal Current Biology, people of Italian and African descent watched short film clips that showed needles pricking black- and white-skinned hands. As they watched, researchers measured the participants' empathy (i.e., their nervous-system activity) by monitoring sensors attached to the same spot on their hands. They also tracked the participants' heart rates and sweat-gland activity, a common measure of emotional response.

"White observers reacted more to the pain of white than black models, and black observers reacted more to the pain of black than white models," says the lead researcher, Alessio Avenanti, Ph.D., an assistant professor of psychology at the University of Bologna.

The researchers also showed clips of a needle pricking a hand painted bright purple. Both the Italian and African participants were more likely to empathize with this intentionally strange-looking hand than with the hand of another race, which implies that the earlier lack of empathy was due to skin color, not just difference. "This is quite important, because it suggests that humans tend to empathize by default unless prejudice is at play," says Avenanti...

..."A doctor with high racial bias may understand the pain of other-race patients in a more detached or disembodied manner and, in principle, this may contribute to the causes of racial disparities in health care," Avenanti says.

Previous research has shown that doctors tend to empathize more with a patient's pain -- and provide higher-quality care -- if they have a history of pain themselves, or if someone close to them has experienced chronic, debilitating pain, Dr. Green says.

"Now we are understanding that if you see someone as being more like you, you can empathize with their pain better," she says. "Race, age, gender, and class probably play a role in how we assess and treat patients with pain."

So does that mean that, say, an African American with low back pain should seek out only doctors who are African American?

Not necessarily. Green says it's more important to find a doctor who actively listens to you and asks questions.

"If you feel you are not heard, or that your pain complaints are not being taken seriously, you can and should see another doctor," she says.

Interesting article and worth keeping in mind around your medical center when you have a varied patient population.

Protecting Your Medical Spas (And Your Own) Reputation Online

Medical Spa MD has been threatened with lawsuits on more than one occasion for something that someone posted in the forums.

If you're running a laser clinic or medical spa you'll have some unhappy patients from time to time as well.. and very soon every one of your patients will have a Facebook page, Twitter stream, or personal blog that provides a public platform for them to voice their displeasure.

In fact, more than 85% of your potential clients who are looking for a medical spa or elective plastic surgery proceedure are doing research online. And it's not just kids. People between 35 and 60 are the fastest growing group online. If you're not the most prominant voice, you're loosing patients, revenue, and reputation.

There have been a number of medical spas and physicians who have literally gone out of business because they were unable to manage their reputation online when it was attacked. (Look at American Laser Clinics reputation.) Trying to 'fix it' with underhand tactics can make it worse.

And there's nothing you can do about it.

Here's a story on CNN about a student who created a Facbook page about a teacher:

A former Florida high school student who was suspended by her principal after she set up a Facebook page to criticize her teacher is protected constitutionally under the First Amendment, a federal magistrate ruled.

U.S. Magistrate Barry Garber's ruling, in a case viewed as important by Internet watchers, denied the principal's motion to dismiss the case and allows a lawsuit by the student to move forward.

"We have constitutional values that will always need to be redefined due to changes in technology and society," said Ryan Calo, an attorney with Stanford Law School's Center for Internet and Society.

"The fact that students communicate on a semi-public platform creates new constitutional issues and the courts are sorting them out," Calo said.

Katherine Evans, now 19 and attending college, was suspended in 2007 from Pembroke Pines Charter High School after she used her home computer to create a Facebook page titled, "Ms. Sarah Phelps is the worst teacher I've ever met."

In his order, Garber found that the student had a constitutional right to express her views on the social networking site.

"Evans' speech falls under the wide umbrella of protected speech," he wrote. "It was an opinion of a student about a teacher, that was published off-campus ... was not lewd, vulgar, threatening, or advocating illegal or dangerous behavior."

Matthew Bavaro, an attorney with the American Civil Liberties Union who is representing Evans, was pleased with the ruling.

"The First Amendment provides protection for free speech regardless of the forum, being the Internet, the living room or a restaurant," he told CNN.

So, while there's nothing you can do to prevent an unhappy patient from broadcasting their displeasure, there is a way to keep that unhappyness from being the first thing that comes up when someone searches on your name or the name of your medical spa or clinic. That's to be the dominant 'voice' that's heard when someone is looking for information about you, your practice, or your services.

So what can you do to protect your personal and medical reputation?

In effect, you need to have a bigger microphone. That means that means that you're going to need to do some heavy lifting online to make absolutely sure that when someone is searching for information on your medical spa, dermatology practice, or plastic surgery clinic, the information that they find is about your practice, not negative comments from disgruntled patients.

And since this is such a problem for every medical practice and physician, we've been looking to help address this need. We're about to launch two new Medical Spa MD Select Partners to help.

The first, Freelance MD, is a creative agency specializing in marketing and advertising outsource services for medical spas and plastic surgeons. The second will be announced later this week.

Freelance MD will be hosing a free webinar on social media marketing this week. (You can see details and register in the previous post.)  If you're not an expert at using search engine marketing, social media, special events and local PR, you'll want to sign up and learn how it's done.

Zerona Lasers

Thoughts on Zerona Lasers

LH (Dr. Lornell E. Hansen II MD) has this comment on the latest Zerona Lasers review discussion around the effacacy of Zerona for 'fat melting' and a study that was just released.

Here's the Zerona Body Sculpting Study

Low-Level Laser Therapy Effectiveness for Reducing Pain After Breast Augmentation American Journal of Cosmetic Surgery Vol. 26, No. 3, 2009
Robert F. Jackson, MD; Gregory Roche, DO; Todd Mangione, DO

LH's comments:

...I do have to apologize as I did not know that the article had been published. The last I had read was that it was waiting for review. I also want people to understand that I am not saying that the physicians involved in the study did anything wrong with my evaluation of the article. I just think that the company is over marketing the product and charging way too much.

My critique:

1. The first thing they teach you in medical school on how to evaluate research is who paid for the research. In this case the sponsor of the research and article was Erchonia the company that makes Zerona.
2. Who wrote the article? In this case the article appears to have been written by Ryan Maloney. Who is Ryan Maloney? He not only is the medical director of Erchonia he actually has ownership in the patent of the Zerona. Other than that you do not know his background. We know he is not a PhD or physician otherwise it would be behind his name under the authorship of the article. He has a direct financial benefit to write the article in a positive light.
3. 8 Individuals did not have final measurements. The first question is why? 4 were from the treated group and 4 were from the placebo group. At first that seems OK, but when you look further into they kept all of these test subjects included in the study. What they did is they took the last measurements for those subjects and carried them forward. Again seems Ok at first but when you start to look at the trend of circumferential loss at the 2 weeks post treatment the measurements are trending back toward baseline. So if you include these patients last measurement (which by the way is the best overall average circumferential loss during the treatments for the treated group) and carry them forward they will artificially lower the true values two weeks post treatment. All 8 of these subjects should have been eliminated from the study.
4. There is no assessment of cosmetic benefit. To have this be worth something you would need before and after pictures that are reviewed by a group of individuals that are blinded to which treatment the individual participant received. So in other words is a 3 inch loss aesthetically significant.
5. They do not state if participants are male or female. So the question is left, does it work as well on males as it does on females? This could be very important as males tend to have thicker skin so does the laser penetrate as deep in men?
6. the study was limited to patients with a BMI of 25 to 30. Now I think it is fine to have this limitation as you have to start your research somewhere. But the limitation is that the article is implying that it will work for all BMI's. What about the thinner female patient with a BMI of 20 but has a small lower abdominal pooch? Or what about the patient that has a BMI of 35? This should be stated in the conclusion but Mr. Maloney seems to forget this.
7. They also do not state if the patients received their treatments for free or if they were compensated for their time. This is only important for the portion of the study that talked about the patient satisfaction. We need to understand that patients will put a value on the treatment because if something is free their expectations are much lower. their expectations are much higher if they paid $2500 for the treatment. So if this was free to the patient and you have 30% of the treated group that are dissatisfied or neutral what would that mean to a clinic if the patients are paying for it. I would guess you will have a much higher dissatisfied group that either wants their money back or free treatments. I do not want something in my clinic that has a 30% failure rate.
8. They do not discuss if either group was asked to change their diets. This should be stated up front in the methods portion of the article. They also do not mention if there were any dietary supplements required such as niacin. Most clinics using Zerona are having the patients take niacin even Erchonia recommends it.
9. They set the standard for success to be an inch loss of 3 inches or greater. Only 62.86% of the treated group achieved success. So this translates in to a 37.14% failure rate. Again, not something that I would want to stake my reputation on.
10. Now what do the numbers mean? If you look at the numbers the patients baseline combined measurement average was 120.31 inches. At week 2 of treatment (the best measurements achieved) the average was 116.79 inches or an inch loss of 3.52 inches on average. This sounds pretty good until you look at the true numbers. Using the numbers from the study this equates to a 2.9% inch loss as measured over 4 areas. Is this clinically (visually) significant? I do not think that most individuals will be able to see a 2.9% change or if they can it will be meaningful.
11. Lets take a look at the 2 weeks post treatment measurements. Remember, these are not true numbers as 4 patients had their best numbers included in these measurements pulled forward and included here. (I think all of their measurements should have been puled out). At 2 weeks post treatment, you see a 0.31 inch increase from the circumferential measurements at the 2 week treatments. What this equates to is an 8.8% increase in inches in only 2 weeks. So what happens at 4 weeks? 6 Weeks? So if it were a perfectly linear increase it would only take about 20 weeks or so to be 100% back at baseline. That is if it were linear and I highly doubt it is a linear response and if i had to guess most patients will be back at baseline measurements within 6 to 10 weeks and this is why there are no long term studies. The company has had ample time to produce longer term studies they apparently do not want to.

So as you can see, there are a few issues with this article and how it was analyzed and written. The first and foremost problem is that the article was authored by an individual with direct financial interest in the product. The ASLMS journal never should have published this article due to the authors conflict of interest or it should have a disclaimer prior to the abstract. I have no vested interest in any of these non-invasive technologies and would love to see something like this work and have long term benefits for the patients. I think this technology may have better long term benefits on cholesterol etc. I have heard that there are some interesting studies coming. I just hope they are not written by Mr. Maloney. And for others reading this I assume that Chad works for Erchonia or the marketing company that is selling this thing to anyone they can including chiropractors.

Sincerely,
Lornell E. Hansen II, M.D. (LH)
www.LazaDerm.com

p.s. Sorry for being so long winded but I could not help myself. I want these companies to be held to higher standards. I think the ASLMS should have higher standards as well.

If you read the thread there's some interesting thoughts that spring to mind. If Chad is not with Zerona it would be the first time in my experience that a patient has been searching for peer-reviewed medical studies before deciding to have a treatment... I'm just saying.

Of course this qualifies as a guest post and a well deserved back link.

Any other physicians using Zerona have any thoughts?

Plastic Surgery Trends For 2010

The Consumer Guide to Plastic Surgery thinks they know what’s in store for cosmetic medicine in 2010, from how the newly proposed “Botax” could affect your self-improvement plans to which new products will come to market. Here's what you might see in 2010:

Even More Botox-Like Products Will Come to Market
First there was Botox Cosmetic; then 2009 brought the Botox alternative Dysport. In 2010, expect to see a few more Botox rivals, including a topical form of the popular wrinkle relaxer and at least one more injectable. A couple of injectable Botox cousins are in development, but PurTox will likely be the next to get a nod from the Food and Drug Administration (FDA). The main difference in these injectables seems to be how long the results last and how quickly the products start to work on your crow’s feet.

Fat Injections to the Breast Will Be Used Cosmetically
After being condemned by plastic surgery associations, fat injections to the breast were deemed OK for "touch-ups" after breast reconstruction in 2008. But these once controversial injections may soon play a role in cosmetic breast augmentation. Taking fat from a part of the body where there is too much (your thighs or butt, for example) and injecting it into your breasts where there is too little, may replace the need for breast implants when done in conjunction with a breast lift. Some kinks still need to be worked out, but fat injections to the breast are likely here to stay.

Surgeons Will Invent – and Perfect – Body Contouring Surgeries to Follow Massive Weight Loss
More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in highly visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. This new surgery targets above-the-belly-button flab, to recreate an hourglass silhouette in formerly obese women and get rid of love handles in men who have lost massive amounts of weight. This area has been ignored by many traditional body contouring procedures that target the lower abs, buttocks and/or thighs. We will hear more about corset trunkplasty and other innovative body contouring procedures in 2010.

Fat Freezing Heats Up in 2010
Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

Cohesive Gel Breast Implants Receive FDA Approval
These so-called "gummy bear implants" have been making their way down the pike for some time, and they just may get the long-awaited FDA nod in 2010. Filled with cohesive silicone gel, these leak-resistant implants – used in Europe and Brazil – are being studied in the United States. Gummy bear implants have the positive attributes of silicone gel, but the gel doesn't migrate. This is a good thing, because if the shell should fail, the gel wouldn’t leak into surrounding tissue.

Lipodissolve Study Results Stun Skeptics
Lipodissolve, an experimental "fat-melting" technology, is being billed as a non-surgical alternative to liposuction. Also called mesotherapy, lipodissolve is performed via injection of a cocktail of chemicals into muffin tops, saddlebags, love handles and other trouble spots to dissolve fat cells. Critics were outspoken, which is why the American Society for Aesthetic Plastic Surgery started a rigorous scientific study of lipodissolve, using standardized ingredients. And while even the trialists were skeptical at first, and the final results have not been tallied, it works. The study results – to be released in 2010 – may encourage many doctors to offer lipodissolve. Still, lipodissolve is only for small areas of localized fat and will never replace liposuction.

“Botax” Will Raise Eyebrows
A health care reform bill will be passed in 2010, and it just may include a five percent tax on all cosmetic surgery procedures (except those deemed medically necessary). Let’s say that breast augmentation with implants costs $10,000 in 2008; add a five percent levy, and the total becomes $10,500 in 2010. With business already down, most plastic surgeons are up in arms about the Botax. There is also fear that taxing cosmetic surgery in the U.S. will encourage many to seek out services abroad or through unskilled providers who offer procedures at cut rates in America, compromising their safety.

Surgery-Free Tummy Tucks Trim Waistlines
Non-invasive body contouring procedures such as Thermage, VelaShape, UltraShape, LipoSonix and Zerona will continue to grow in popularity in 2010. Once reserved for the face,

Thermage also uses radio waves to lift and firm skin on your stomach, knees, arms, legs, hands or butt. VelaShape employs bipolar radiofrequency energy to reduce the size of the fat cells, along with infrared heat to tighten the skin. And Zerona uses a “cold” laser to painlessly zap the fat cells beneath your skin. These technologies (and more) may give tummy tucks and lower body lifts a run for their money in 2010.

Face Transplants Face Upsurge
Face transplant surgery was once nothing more than fodder for sci-fi thrillers like the movie Face/Off, but they are now becoming a reality. Eight have been performed so far in the United States and abroad, but there will likely be many more as reconstructive facial surgeons further hone their skills and work toward perfecting their highly complicated techniques.

Minimally Invasive Cosmetic Procedures Experience Rebirth
As our economy starts to show signs of life again, more people may opt for cosmetic surgery procedures, reversing the steep decline of the last two years. Don't expect the numbers to reach their record highs anytime soon, though. There will likely be a slight increase in plastic surgery procedures – especially minimally invasive ones such as injectables that allow people to put off more invasive (and expensive) procedures like face lifts until they really need them (and can better afford them).

Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories. Consumer Guide to Plastic Surgery is a registered trademark of Ceatus Media Group LLC. http://www.yourplasticsurgeryguide.com

Medical Spa MD Training Courses

Finally available! The Medical Spa  MD Training Courses for Laser Clinics, Medical Spas, Plastic Surgery Centers and Cosmetic Dermatology Practices.

Your medical spa staff's knowledge and expertise is a critical componant to your medical spa or cosmetic clinic's success.

From IPL training to skin typing, Botox, Restylane, and Juvederm filler injections, the Medical Esthetician Training Manual & Study Guide, and the Advanced IPL & Laser Training for Non-physicians is required material for smart medial spas, plastic surgeons and cosmetic dermatologists.

Now it's easy to train every new hire on what non-surgical cosmetic proceedures you offer, how they work, and what alternatives there are. Ensure that your front desk, estheticians and laser technicians have the information that they need to answer patient questions with confidence.

For the first time, your laser clinic or medspa staff has the latest information on the newest nonsurgical medical treatments. From Botox, Restylane, and the newest filler injections, to fractional CO2 laser resurfacing, skin tightening and IPL treatments, now you have a uniform and tested training system. This is a must have for any serious cosmetic clinic.

Download Advanced IPL & Laser Training TOC
Download Medical Spa Aesthetics Training Course TOC

Advanced IPL & Laser Training Manual

The Advanced IPL & Laser Training Manual for Non-Physicians is required training material for every new hire working in a medical spa.

From IPL to fractional laser treatments, this manual covers the non-surgical IPL & Laser treatments your staff should know. Give your staff the information that will make you successful.

Advanced IPL & Laser Training - $227

Medical Estheticain Training Manual & Study Guide

 
The Advanced Medical Spa Esthetics Training Course & Study Guide is a two part learning cirriculum for non-physicians.

With 165 pages of quality content, this course is delivered in two parts that include a text book and a study guide. Already being used by leading medical spas and esthetician schools.

Medical Spa Aesthetics Training Manual & Study Guide - $247

Get all three and save: The Medical Spa Aesthetics Training Manual & Study Guide AND The Advanced IPL & Laser Training Manual

Buy the Medical Spa Aesthetics Training Course & Study Guide AND the IPL & Laser Training course and save almost $200!

 
Medical Spa Aesthetics Training, Study Guide, and Advanced IPL & Laser Training - $297

These training manuals are a critical component to the success of any Laser Center, Med Spa, Plastic Surgery or Cosmetic Dermatology practice. Use them to train every new medical spa staff member on what cosmetic proceedures are available, how they work, and what alternatives there are.

Written for non-physicians, both of these advanced training courses are already being used in leading medical spas and laser clinics to provide every new medical estheticians, laser techs, and front desk staff with current information about cosmetic information, and test their knowledge before they're hired.

Written by Paula D. Young, RN, these training manuals are designed to meet the real-world needs of cosmetic practices by those who know how to run a succesful cosmetic practice and how important it is that your staff is trained and has the information they need to become trusted avisors to your patients.

Everyone who has owned or run a med spa or cosmetic practice knows how long it takes to train new staff, and how much damage can be done with the wrong information. These new manuals and study course from Medical Spa MD make it easy to provide consistant, quality information to staff and ensure that everyone is on the same page from day one. Your entire staff now knows what your education expectations are and have the materials to meet them.

From Thermage to IPL to fillers and chemical peels, how they work, who they're for and when to use them. These courses give your laser techs, medical estheticians and front desk staff a deep understanding of the landscape of nonsurgical cosmetic medicine and save you endless hours of repetitive individual trainging. It's the single best investment you'll make in your medspa.

Give your staff the benefits of insider knowledge and make sure they're making the right decisions.

Care Credit - No Longer Practicing Medicine

I was included in an email from a fellow MAPA member yesterday with some urgency regarding Care Credit ceasing to do service with their medical spa.

This physician was to the understanding that Care Credit is suspending its services to any practitioner who is not a plastic surgeon, dermatologist, cosmetic dentist or veterinarian.

Immediately my stomach got tied up in knots as I thought “here we go again... another RealSelf debacle!”. I decided to get that facts for myself being that our practice is a non-plastic, non-derm facility.

During the call I found out that this rumor is partially true in the fact that Care Credit is suspending services to facilities that:

1. Do not have a physician on site approximately 60-70% of the time.

2. To physicians who are primarily medical directors that mostly travel between facilities.

3. To practices that do not have at least 60-70% of their services being cosmetic in nature.

4. Practices that perform medical care, critical care, fertility services, long term care, pain management and weight loss services that occupy the majority of services in their practice.

5. To physicians who do not perform at least 60-70% of those cosmetic procedures themselves.

In talking with the customer service rep, she said they have made this decision to "consolidate their strategic image" and they are not “singling out” any specific specialty. She said their main decision to decline some accounts is because they don't want to stand in the way of a medical patient receiving experimental care, or a procedure that an insurance company won’t pay for that is considered medical in nature. Although not deemed “medical” in nature, per se, fertility clinics are also being denied services. In discussing the board certification requirements, I could not get a clear and decisive answer other than physicians need to be board certified. Period.

She also told me that she could tell by our account number (the 4 digits in the center) that our account with them was initially set up as a cosmetic practice and not internal medicine. Those identifying numbers is what triggered letters to go out to certain practices and not others.

She went on to say that if anyone feels they do 60% or more cosmetic services, and the doctor is on site and performs at least 60 % of those services, they can call to dispute.

So, to clear things up for those of you who are uncertain as to your status, I asked for a copy of the letter that went out and I think it’s pretty self-explanatory. Here’s the crucial part of the letter:

“GE Money Bank continuously reviews our portfolio and lending criteria to anticipate and respond to market conditions, consumer needs, and strategic fit.

Upon review of our portfolio, we have determined that we will be limiting our lending partnerships in the cosmetic market to Board Certified Plastic Surgeons, Facial Plastic Surgeons, Dermatologists, and a small number of other Board Certified specialties performing cosmetic surgery.”

I have also heard rumors that Chase Health Advance is, or will be, taking similar action. My closing thought is, if you didn’t get a letter, then chances are you have not been rejected.

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.

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