Lipodisolve: Mesotherapy Horror Posts!

These posts about mesotherapy were taken from discussion threads on this site.

 
The individual comments have been removed from the discussion threads for obvious reasons but are reposted here:

Yono writes: I am a nail salon owner and learned it from a friend. It works great and you do not need a prescription ! Go online for the best prices and instruction. Mesotherapy is great for anyone and you don't have to go to France!

JJlin writes: Anyone can perform mesotherapy. I tell people its cheaper to inject yourself in the comfort of your own home. You can purchase sterile needles and mesotherapy injectables online, compounding pharmacies, just about anywhere. Instructions online as well.

Aestheticianspa writes: I perform manicures, mesotherapy, botox, and laser hair in my garage transformed into a spa like office. I think anyone can do it as long as you have a doctors lisc. Just send em the check every month. :)

And Cosmo: Its pretty safe and effective. You can pick up the solution at any compounding pharmacy or online and inject it yourself. I tried it many times on a friend. Real easy for anyone. Go for it.

JJlin again: I agree w/ Cosmo. Who cares if it works or not? Everyone should get into Mesotherapy. Its cheap, easy and good cash.

Where to begin. It seems hard for me to believe that this kind of activity is actually happening let alone there are those who are posting that injecting yourself or others in the comfort of your home or garage is a good idea. The stupidity is overwhelming.

If you are injecting anyone and are not a licensed medical provider you are practicing medicine without a license, a felony in every state. If you are injecting yourself you are just plain stupid and should be removed from the gene pool as fast as possible. It's no wonder that mesotherapy has a hit-and-miss reputation for being pseudo-garage-science.

Medical Spa Legal Issues: New Q&A Discussion Area

I added a new discussion area called medical spa legal Q&A

 

In order to address a host of questions that I receive by e-mail and are carried on in discussion threads in other areas about what is legal or illegal, how physicians can structure a business with a non-physician, who can perform treatments, what the scope of practice is, what constitutes direct medical oversight, how you find out what your state regulations are, etc.

I have noticed that there have been a number of postings by non-physicians that are blatantly wrong, and so we are offering the legal area in order to have a little continuity where our physicians can get information that is at least slightly moderated and not full of spam and nonsense. If you have a question about any of the legal aspects of running, owning, operating a medical spa, read the medspa business discussion or the physician to physician threads as well as some of the other postings about opening a medical spa, building a medical spa inside your practice, etc.

None of the comments or posts are offered as legal advice. Consult your attorney before you do anything stupid. 

Cutera Xeo ND Yag For Leg Veins

I have to say I've been unimpressed with Cutera Xeo and its ND Yag laser for vein treatments.

Previous post: Cutera Xeo. Does it work?

We took possession of one of these Xeos about two months ago and have since treated a couple of patients, including some of our physicians and staff so that we could keep close tabs on both how well we thought it works as a treatment, the efficacy, time, etc. I have to say that we're somewhat unimpressed. My staff of physicians are really down on it, having used is on their own leg veins and seeing either such light results as to be nothing, or actually an increase in the visibility of the veins, which is exactly what we didn't want.

Another problem was found where, after a Yag treatment, one of my staff was injected with Sclerotherapy and had a previously unseen  and unwanted reaction in which the vein blanched black, something none of my physicians had ever seen before. One of our physicians was a big proponent of this Cutera, but as I said, we've so far been less than impressed. I would like to hear if anybody else has better results.

Laser treatment for veins, of course, are becoming increasingly popular and, to be honest, they're more profitable since they seem to be worth more to the patient and hence, you can charge more. At one of the seminars or symposiums I came away with the feeling that great reactions from a treatment with  lasers hovers around 5%, which I find abysmal.

Anybody with views, I'm happy to hear them because that's about a $130,000 piece of equipment and I would like to be able to get some use out of it rather than getting rid of it. I have to get multiple physicians to agree on it however.

Palomars Medilux, Starlux, & Estelux

The Palomar Starlux is being sold in droves and has created a heavy secondary market for their Medilux and Estelux platforms.

 
The Starlux has a significant power increase over the Medilux and the ability to add any head they want. Supposedly, the Fractal heads from Palamar (or the Fractal rip off head) should be available soon.

For many treatments, however, the Medilux or the Estelux have enough power. In fact, you might now want to have all the power that the Starlux has because you have to be a little bit careful, depending upon the heads you're using.

An interesting note is that the Estelux head works perfectly well on the Medilux, except that the plastic part around the connection is a different configuration. I have seen Estelux heads configured so that they run on perfectly Medilux devices, making the cost per head dramatically lower. I wouldn't be surprised if somebody actually turns this into a business.

Does anyone know where Estelux heads can be configured to run on a Medilux?

Is Thermage Making A Comeback?

Thermage may have weathered the storms that plagued them early on. Poor training. Poor reviews. Unhappy doctors.

At a meeting this week a Thermage rep told me that they had just had the most profitable four months since they launched. The initiation of Thermage body and eye treatments seems to have helped in addition to making the treatment head bigger.

I've posted on how Thermage brings out the heavy anger here.  Some docs think Thermage is a totally bogus technology. That's the rep that many new treatments encounter. I think Thermage brought most of that trouble on themselves with inadequate training and price gouging. The move to quicker treatments with bigger heads (effectively cutting the price) is a step in the right direction. Thermacool as a treatment is improving, Thermage as a company has been a pain in the ass. I hope that is changing.

If Thermage is going to compete against Cuteras Titan, Fraxel, Palomar's Fraxel head for their Starlux, and whatever else is coming, They're going to have to continue to innovate and out compete. No one likes paying $650 for a piece of plastic and chip that costs $8.

Doctors & Staff Issues: Listen Up

It still surprises me how poor many physicians are when it comes to interacting with staff. I've ended up in the middle of a total non-event in one of my clinics in which the doctor overheard a technician speaking to a patient about a treatment. The tech was informing the patient that the time constraints (the patients) wouldn't allow the treatment to be performed and we would have to reschedule. The physician overheard some of this conversation. But instead of speaking to the technician and finding out why the tech took the action she did, he and the office manager got me involved. From what I gathered the laser tech took the appropriate action, the patient was happy, case closed. But my doc sees it differently even though he never spoke to the tech.

Inside any successful clinic there is a huge amount of staff interaction. Physicians or managers who don't really talk to their staff every day will make poor decisions on partial information. 

Top 10 lies of medspa technology salespeople.

These are the lies of salespeople from IPL, laser, and technology companies.

1. "We're committed to helping you grow your business."  This means that the salesperson has attended sales training and memorized a list of popular sales pitches. The information and 'sales growth' kits available from the tech companies are really pitches for building their name recognition. Sales people get paid for selling. Once your sold, you're in.

 2. “This is how (name of competitor medical spa) did it, and it worked.” If a tech salesperson is telling you about your competitors, they're telling your competitors about you too. The only contact sales staffs have are sales related. The information passed around is just what someone told them was the case.

3. “We'll take care of training your staff.” Lasers and IPLs almost always come with training packages. The sales rep will come in and give you a day or so of time. The rest will be up to you so you'd better attend as well since you'll be doing the training from now on.

4. “This is an easy business decision.” This is not an easy business. One of my buddies is one of the largest buyer and seller of used aesthetic equipment. He buys it from docs going out of business and sells it to docs going into business. (The salient part is docs going out of business.) This is a 'retail' medical business, not an easy one.

5. “This is how much this IPL/Laser/whatever costs.” The retail cost of lasers and IPL's is far above the street cost. Check out these listings on Ebay. A Cutera Xeo with a list price of $127,000 has a street value of around $70,000. Unless you need support or this is your first device, you will want to investigate used equipment.

Add your top lies of tech salespeople in the comments and I'll add them to this list. 

Botox Uses Are Expanding Daily

Indications for use are expending daily:

Overactive bladder, diabetic nerve pain, excessive sweating, migraine headaches, voice tremors — these are just a few of the conditions that the drug Botox can treat.

This week came the news that yet another condition might be alleviated by Botox — benign prostatic hypertrophy, or prostate enlargement.

Botox's manufacturer, Allergan, says that it is one of the most used medications worldwide, approved for 20 problems in more than 75 nations. This list will likely grow as new discoveries are made.

How did one drug — which was originally approved to treat excessive blinking back in 1989 — become so useful? The answer lies in how Botox can be injected directly to the source of the problem — usually an overactive muscle, gland or nerve connection — with few lingering side effects, making it easy for scientists to experiment with it on different problems.

"Every group of physicians that have taken on botulism A have found innovative uses for it," said Dr. Alastair Carruthers, a clinical professor of dermatology at the University of British Columbia. Carruthers is also half of the husband-and-wife team that first reported Botox's cosmetic use in the 1990s.

American Laser Clinics Hires Armed Guard To Prevent Doc From Seeing His Own Patients.

American Laser Clinics decided to wage war on one of their medical directors by hiring an armed guard to prevent him from seeing patients or accessing charts while continuing to treat patients and insisting he was providing oversight.

American Laser Clinics (purchased Advanced Laser Clinics but kept the ALC so that they didn't need new monogramed towells) has a number of laser hair removal clinics around the country. (You can read more about my thoughts on medspa franchises and ALC here.)

Evidently, American Laser doesn't like any lip from physicians. Check out this photo showing a guard standing in the waiting area of American Laser Clinics to prevent the doctor from seeing patients or seeing charts. While the headline appears tabloid, it's completely accurate. The physician concerned contacted me for my opinion as well as DOPL (the Utah licensing enforcement agency).

(This is an article in progress. Check back later.) 

Cutera Xeo - Laser Genisis? Fraxel? Titan? Does it work?

I've just brought in a Cutera Xeo.

After hearing a lot about Cuteras Xeo with Fraxel, Laser Genesis and such, we're going to check it out side by side with our Palomar IPLs, Cooltouch Lasers and Thermage. The scuttlebutt is that Fraxel's still largely unproven and Laser Genesis is something of a joke but we'll see. We have a number of patients we're going to use to see if we can determine a victor. We'll post the comparisons and thoughts here.

Cutera has been heavily promoting Fraxel and Titan. We shall see.