Medspa Mentor: Your patients don't feel average

It might be obvious but I've had a number of conversations on this basic topic lately about 'average medical spa patients'.

00115-g11.jpgFrom my buddy Shmula who designs systems. 

Most organizations collect and report on metrics that are not descriptive of their processes. Some of you may have noticed that most metrics that are reported are the “average” or the “median”. Most people do not understand elementary statistics and their application to business. Here is the truth of the matter: Your customers do not feel the average — they feel the variation.Make

sure that your metrics reflect what your customers are feeling. The “average” is an inadequate measure and is not descriptive of what the customer is feeling. There are other measures that basic business statistics makes available to us that will help us (1) understand the customer better, (2) understand better where we can improve (3) identify ways in which we can further delight the customer.

Pete's exactly right and worth repeating.

Where Pete is talking about 'deviation from the average' as outside what the patient has come to expect, I'm using that term to highlight how a medical spa or physician looks at and services it's patients. There are any number of times when I've heard physicians or staff discuss 'average' patients.

When you first open your doors you are thinking of 'the sale', if you begin to achieve some level of success this quickly morphs into 'sales' and generalities begin to set in. You begin to use things like average sales, average consultations, average everything.

In and of itself that's not a terrible thing, except when it bleeds into patient interactions. If your 'average' patient spends $250 on Botox, a patient who's spending $150 might be thought of, and possibly treated in some subtle way as "below average". Are they? No. The average is an abstract construction that should remain in the realm of accounting. Don't let it migrate into your customer service. It's poison.

Your patients do not feel average.

The new medspa & Trolly Square shootings.

13slay2_lg-thumb.jpgLast night I was looking at a space for a new medical spa in downtown Salt Lake with a friend of mine Shane and his 4 year old son. We dicided to have an early diner and Shane suggested The Spaghetti Factory at Trolly Square since they provide ice cream with every meal. A 4 year old's favorite.

Half an hour after we left the restaurant an 18 year old with a shotgun, handgun, and a chip on his shoulder walked in the sam door and open fire on the diners and others in the mall. Five dead and four others in critical condition.

You never know when your life will change. 

During my 10 years in Manhattan I saw guns pulled five time in anger. Gun violence is becoming a part of everyday life in America.

Lip augmentation gone Frankenstein!

Misadventures in lip augmentation.

"Pop star Pete Burns revealed today he is suing his plastic surgeon for "wrecking his career and life".

Burns, singer with 1980s pop band Dead or Alive, has had several cosmetic procedures on his face and is suing a Harley Street surgeon for an estimated £1million over a botched attempt to remove lip implants.

In an exclusive interview he told the Standard he looked like he had been "mutilated with a Stanley knife" after surgery to correct the original problems left his top lip hanging off...

Burns said: "It has taken away my life and my career. I saw doctors in London who said the only option was to amputate my lips. I was suicidal."

In 2000 Burns went to Dr Maurizio Viel at the London Centre for Aesthetic Surgery to have a lip implant removed.

lips250107_243x205.jpgBut instead of having the original implant taken out, he was injected with a filler called Evolution and then later with another called Outline.

Despite complications, Dr Viel persisted and injected more of the substance - only for the problems to escalate, causing swelling, blisters, discharge and lumps.

Eventually the singer was left so disfigured he could not eat normally, could only drink through a straw and did not leave his house for months."
Lip augmentation is still a proceedure that has risks. Lip amputation?

 
In Park City, we perform a lot of fillers, but in any normal situation, we avoid the permanent ones like Silikon 1000. There are docs that use this stuff like it was apple juice just because it's cheap and they can charge more for 'permanent fillers'.

It's not always just the cost or how much you can make. Putting a patient at increased risk just to save money or charge more for a treatment is not ethical behavior. 

Hat tip: Plastic Surgery 101 

Inside Sona Medspas Part 7: Required IPL's & Lasers

 Medical Spa MD - Inside Sona Medspas Part 7: Required IPL's & Lasers

These posts are written by former Sona Medspa owner Ron Berglund to provide an inside view of the way medical spa franchises recruit, train, and support their owners as well as detailing some of the problems with medspa franchises.

Read Part 1: Why I bought a Sona Franchise l Part 2: Sona Promises l Part 3: The Franchise Pitch l Part 4: Legal Structure & Revenue Sharing l Part 5: Opening a laser clinic l Part 6: Medical Directors & Physician Oversight

Sona Medspas: Required IPL's & Lasers

 

acclaim_7000.jpgWhat IPL's & lasers did Sona mandate? 

When Sona rolled out its original franchise program in late 2002, the only service specifically discussed in the written documents was "laser hair removal". There were some vague references to other services but there was nothing specified at this point. In addition to a franchise agreement, and possibly an "area development agreement", Sona required franchisees to execute a "laser placement agreement" ("LPA"). The LPA stated that initially two Cynosure Apogee 9300 (long-pulse alexandrite) lasers with accompanying Smart Cool chillers would be installed for each franchised center. Based on sales revenues over the term of the agreement, additional lasers would be installed as different revenue "benchmarks" were achieved.
 
This program seemed like a good deal at the outset. We would not be required to lease or purchase this very expensive equipment (each laser + chiller had a retail list of about $90,000) and all payments and service would be taken care of with our monthly revenue share payment.
 
The standard franchise agreement and LPA provided that Sona's monthly revenue share-- which covered laser placement, service and maintenance in addition to the Sona franchise fee-- was based on a sliding scale which initially ranged from about 27% of gross sales for sales under $60,000 per month dropping to about 15% for sales over $100,000. As the franchise evolved over the first sevral years this program changed significantly. By late 2004 Sona switched to a new program whereby franchisees were encouraged to lease or buy their lasers. In addition to Cynosure lasers, Sona also allowed franchisees to purchase Orion/Alma lasers as well as the Harmony IPL ("AFT") System as the service offerings of Sona had also expanded considerably by this time.
 

What technology decisions were elective?

Initially, franchisees were not permitted to use any equipment except for Cynosure (we found out later in litigation that Cynosure had a significant ownership interest in Sona-- I believe 40%-- which was not disclosed to us).
 
When Sona initially rolled out its new "skin rejuvenation" program a variety of additional equipment-- also Sona mandated-- was required. During the first wave of this program my partner and I leased a $50,000 equipment package which included a VISIA imaging booth, DiamondTome microdermabrasion system, and ultrasound imaging and treatment systems. We also briefly tried to use the Photogenica "Mini V" pulsed dye laser also sold by Cynosure. Subsequently Sona entered into an agreement with Orion (now Alma) and the Alma lasers and Harmony System became available for lease or purchase.
 

Did Sona get kick backs" that you know of?

Many of the franchisees engaged in gossip about this. We heard "through the grapevine" that Sona did not allow us to use Lumenis equipment because Lumenis refused to play these games. I clearly recall a statement by one of the Sona officers at their big national meeting in March 2004 that if we purchased the new skin rejuvenation package from Sona we would be able to take advantage of their volume buying discounts, etc. Naturally, I was dismayed when I later received the cost breakdown on the included equipment and saw that all equipment had been sold to us... surprise!, at retail list prices.
 

Did you interact wth the technology companies directly? 

Since I ended up with ten pieces of Cynosure equipment you can imagine that I interacted with Cynosure a great deal. My interactions with the other companies were minimal. We found the Cynosure lasers to be hugely problematic. The treatments-- whether with the Alexandrites or Nd:YAG-- were extremely uncomfortable for many of our clients. The efficacy was far short of what we had been led to expect from Sona--- and from Cynosure's very limited representations (their web site at the time mentioned that most people are satisfied after four treatments which is ridiculous). Most important, the Apogee 9300s were VERY high maintenance and required extensive service. These lasers are gigantic-- and whenever repairs were required-- even simple flash lamp replacement-- it was necessary to have a Cynosure service technician perform the repairs on site. During part of the time I was operating we had a service technician in the Twin City area but on many other occasions technicians were flown in from all over the U.S.  This was not my problem during the term of my Sona franchise, but when I later effected a "divorce" from  Sona it became a huge-- and expensive-- headache. 
 
One of the biggest problems with the Sona program is that the agreements did not provide for the aftermath. As our lasers began to wear out from extensive use, neither Sona or Cynosure had any specific requirement to replace them with new ones-- even though we were initially still required to fork over typically about 22% of our gross revenues to Sona in exchange for having our equipment provided. The only "blessing" I received is that after using the lasers heavily (and paying for them heavily) for two years I was allowed to purchase them at their depreciated cost of $7500 each. This "blessing" was significantly tempered by the amount Cynosure required for an ongoing service contract (over $12,000 per year PER LASER !) and the value of used Apogee 9300 lasers on the resale market. Needless to say, I was appalled to find that lasers I had payed almost $100,000 each for just a couple years ago were now virtually worthless.
 

Two very important lessons: 

  1. Always find out-- and get in writing-- the costs of service and maintenance AFTER the product warranty expires, and
  2. Check out the values on the current used market of the device you are looking at-- there are a number of companies on the Internet hat are doing a lot of this.
Good to know this up front. I could not even GIVE AWAY my used Apogee 9300 lasers because prospective buyers found they could almost get new equipment with warranties for very close to what they would be paying just to service my old lasers!  

Manimal: Animal-human hybrid cloning

Whoa. Attention grabbing headline. While its still a ways from The Island of Dr. Moreau, it's not as far as it once was. 

manimal.jpgAnimal-human hybrid cloning deferred 

 
Controversial proposals to make embryos by merging human and animal material remain on hold following a decision on Thursday by the UK regulator of embryo research.

Under intense pressure from scientists to allow three UK teams to make the embryos, the Human Fertilisation and Embryology Authority decided instead to hold a public consultation on the issue.

hat tip: Inevitable.org/anism 

Cosmetic Medical Abbreviations For Physicians


Some of the humorous acronyms and abbreviations found in medical spa charts.

If you have an addition, add it as a comment to this post and I'll bump it up. No complaints that physicians shouldn't ridicule their patients.

medical_abbreviations.jpg

ADR - Ain't Doin' Right.

IWF - Imaginary Wrinkle Finder 

ATSWWT - Always Thinks Something's Wrong With Them.

CTD - Circling The Drain.

DAAD - Dead As A Doornail.

55W - Fifty Five & Wrinkly

BPC - Botox Poster Child.

WICDM - Wish I Could Do More. 

NMTBD - Nothing More To Be Done. 

FLK - Funny Looking Kid.

FOS - Full Of Stool.

FTD - Fixing To Die.

DSFD - Doc-Shopping For Deals.

FTW - Friggin Train Wreck. (Patient with multiple problems)

GFPO - Good For Parts Only.

GGTG - Gomers Go To Ground (they fall out of bed or gurneys).

GLM - Good Looking Mom.

TYTLFSS - Twenty Years To Late For Sun Screen. 

GOMER - Get Out of My Exaimining Room.

LOLINAD - Little Old Lady In No Acute Distress.

MFC - Measure For Coffin.

NFFM - Normal For Full Moon.

O2T - Oxygen Thief.

ODD&DDR - Out 'De Door and Down 'De Road.

PBBB - Pine Box By Bedside.

FFOBR - Forty Feet Of Bad Road. 

PITA - Pain In The A**.

SALT - Same As Last Time.

SWAG - Scientific, wild-A** Guess.

RTNIFL - Refer To Newbie Internist For Laughs.

TOBAS - Take Out Back And Shoot.

TTGA - Told To Go Away.

WDWNF - Well Developed Well Nourished Female.

Humorous Medical Abbreviations

Medical Spa Videos: From the LA Medspa Expo.

Medical%20Spa%20Expo%20Logo.jpgIf you haven't been to one of the Medical Spa Expos, here's your chance to see what you're missing.

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

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

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

 

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

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

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

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

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

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

Do all doctors need a medical spa?

I had a very interesting day speaking to visiting doctors at Surface.

hdache-9.jpg
It's quite common to receive requests for physicians to contact us for input. This generally comes in a number of forms. The 'send me your sales information' is one that I generally don't respond to. It connotes a lack of depth and understanding and I've found that most physicians who solicit this kind of info have not been investigating the market long enough to understand what they need. They're just shopping around and don't really understand what they're trying to do. (At least that's my impression.)

Then there are physicians who contact us in a way that shows that they've been investigating the market, possibly lurking for some time and reading in an attempt to make informed decisions. I always respond to these physicians since I've found them to be the type of doctors we're looking for.

I receive that type of question a lot; 'what type of doctor are you looking for?' My answer is always 'smart and motivated'.  Monday I met with two of these latter type of docs. (At least that's my current opinion.)

RB MD is a cardio thoracic surgeon who's been practicing for 20 years in a different state. His credential list is as long as my arm. He told me his average take home check for heart surgery and 60 days of post op care... is $1800. RB MD would like to have his life back. He'd like to spend some time with his wife. He'd like to have an income that wasn't dependant on others. In short, he thinks he'd like to have a cosmetic practice. I think he will and I think I'll help him.

KN MD is an associate professor in internal medicine and practices at a hospital. She's also taken a look at the medical landscape and decided that she doesn't like the lay of the land. She's wants to move into cosmetic medicine too.

Why don't these doctors buy a medical spa franchise? Possibly because they don't see what value they add. DermaDoc, a Dermacare owner, will be surprised to hear this but he's the happiest medical spa franchisee I've ever interacted with. He describes himself as merely frustrated. Most medical spa franchisees say something different.

So why are internists and surgeons so unhappy with regular medicine that they want to get out of it?

Doctors Without Dollars

"Removing hair from unmentionable parts of ladies in Westchester County is how my friend Jerry spends a good part of his week. Not that there's anything wrong with that, except Jerry (not his real name) is a cardiologist, trained at one of the finest medical programs in the country. Trained to save lives. His expertise is the complex and delicate management of congestive heart failure, but he gets paid a lot more to do a laser Brazilian."

Comments welcome.

Dermacare sends Medical Spa MD a cease and desist letter.

Dermacare Laser & Skin Care Clinics sent me a nasty cease and desist letter.

 
It seems Dermacare objected to their mark on this page where some Dermacare Franchises posted less than flattering comments.

Certainly its every businesses right and obligation to protect their intellectual property. (I've removed the offending image.) It's also true that Dermacare has a reputation of trying to quash anyone who questions their business practices. As DermaDoc says:

"I appreciate the option for more open communication in a confidential fashion, but at least for the time being, I don't want to subject you or us to potential litigation / subpoena action for any type of mis-statements perceived by Dermacare. Corporate is very open about how many cease-and-desist orders and lawsuits have been filed to 'protect their name'."

Good call DermaDoc.

I would have suggested that Dermacare take a different approach and send me a list of happy doctors and plump testimonials. In fact, since I know at least someone at Dermacare reads this...

Open Letter to Dermacare & Dermacare Medical Spa Franchisees 

Dear Dermacare Laser & Skin Care Clinics,
This is an open invitation to send Medical Spa MD any number of physician contacts who are happy franchisees. Here's your big chance. With more than 8000 monthly readers you'll have an opportunity to get your message and testimonials in front of a large number of physicians who are actively seeking information. I will print any current franchisee's opinion as a separate post in it's entirety.

If you are a Dermacare Franchise, please send me a testimonial or comment of support from your corporate email (which I have) and I'll post it as well. (You may of course just comment below if you wish.)

So lets hear from the franchisee's. I'm as anxious as anyone to know if I should change to Dermacare's franchise model.

I wonder if It was Dermacare that sent me this previous email threatening me with imminent criminal sanctions. Hmmm.

I did a search on medical spa lawyers and found that S.Blair is an attorney practicing medical spa law in Arizona... Coincidence?

Here's what S.Blair said:

"The legal information and comments made in this site are wrong. I am an attorney who has been contacted by one of your readers. The reader wants to take legal action against the owners of this blog. You need to have your comments reviewed by an attorney before posting any further blogs."

and an email: "I am an attorney. First, the legal comments and advice you are providing constitutes the practice of law and, thus, you could be facing criminal sanctions. Second, I have been contacted by one of your readers you wants to take legal action against you for improper legal advice. I suggest that you refrain from providing any further legal advice in your blog or have it reviewed by an attorney before posting it."

S.Blair (Unregistered. No profile. Email entered is .......00@hotmail.com)

My suggestion is still to retain lawyers who don't have hotmail accounts. Is this an X File? Perhaps its that Arizona sun.

PS: Future interactions, threats, letters, or whatever will be posted on this site as well.

YAZ & Acne

Yaz_logo.pngWashington — The Food and Drug Administration (FDA) has ruled that the oral contraceptive YAZ can also be used by women to control moderate acne.

“Perhaps the biggest problem we have with acne treatment is our patients’ poor adherence to the treatments we recommend,” Steven R. Feldman, M.D., professor of dermatology at the Wake Forest University School of Medicine, tells Dermatology Times. “YAZ being approved for acne in women who want to be on an oral contraceptive means that if these patients are going to take birth control pills in a reliable way, the acne treatment adherence may ride the coattails.”

According to an Associated Press report, the FDA’s ruling makes YAZ, made by Berlin-based Bayer Schering Pharma AG, the first oral contraceptive to gain FDA approval for three distinct uses: It’s also approved for treating the physical and emotional symptoms of premenstrual dysphoric disorder.

“I’m excited to have yet one other option for hormonal control of acne for my patients,” says Joel Schlessinger, M.D., director of Skin Specialists PC, Omaha, Neb., and president of the American Society of Cosmetic Dermatology & Aesthetic Surgery. “Many of my patients are looking for ways to get off of antibiotics after the reports of breast cancer increases in women on long-term antibiotics, so this provides an easy way for those women who are already on contraceptives to address two problems at once.

“Additionally, with YAZ’s indication for premenstrual mood disorders, it seems like it will be popular with many women as well as with OB-GYNs,” he tells Dermatology Times. “We find, however, that county clinics and Planned Parenthood tend to wait a while before they prescribe these newer contraceptives due to cost considerations, so hopefully this won’t limit our patients’ access to it.”

Medical Spa MD: 8000 monthly visitors

brochure.jpgWow. Medical Spa MD had more than 8,000 unique visitors and 60,000 page views last month. 

I'd like to express my thanks to everyone who submits, comments, or lurks.

While I've been threatened with lawsuits when someone doesn't like what they find here, it's the growing community that makes the upkeep of this site worth it to me. Certainly this is the only place on the web I'm aware of that isn't part of the paid party line.

For those who contribute; Midwest, Dermadoc, Ron Berglund, Dermgal, ChicagoMD, Karen PA-C, MD, Docsocks, Aesthetic RN, Aesthetic Physician, and everyone else who's contributed in any way to this site. Thanks. I know enough to know that I'm not the only voice in the cosmos/

We're actually going to be improving a number of things around here. Medspa Physician Job Listings will be posted in the next few days and there are a number of physicians and medspa owners who've contacted me about possibly writing for this site. Classified listings for or by medspa physicians will be up for 180 days and are completely free.

The Aesthetician to Esthetician Discussion Area has also been opened for aestheticians to ask questions of others.

So thanks, and if you're a lurker, go ahead and comment. If you have an opinion we'll all learn something. 

Physician Oversight: Michael Cohen, Camlaw

lethalinject.jpg

Medical Spa legal issues post by Michael H. Cohen, a lawer who deals in this area.

Medical Spa Legal Issues

Laser Therapy Physician supervision requirements can make delivery of medical spa therapies expensive. Some spas opt to have medical directors off-site and on the books in name only, thus providing a panoply of inexpensive therapies through various providers. Is this legal? It depends.

Read the post here.

Medspas: Publicity without a press release (or the press)

Long Tail PR: how to do publicity without a press release (or the press)

Here's something you can put your medspas office manager on.

Press is not difficult if you're willing to take the time to learn how to do it. Medspas and cosmetic medicine in general are competitive. To win, you have to be willing to compete. Learning how to do things yourself is probably the most cost effective way.

I've been following the debate started by Brian Solis about "social media press releases" and other forms of doing PR in a way that both works in a conversational medium and doesn't demean and insult the intelligence of everyone involved. As far as traditional media goes, I suspect none of this matters much--most journalists have long ago figured how to quickly decide if they have any interest in a press release and how best to extract whatever value is in it. The system is no more or less broken than it's always been.

But what about the Long Tail of media--all those new influentials, from the micromedia of Techcrunch and Gizmodo to individual bloggers? And the social news aggregators like Digg and our own Reddit? They're where the most powerful sort of marketing--word of mouth--starts, but most of them don't want to hear from a PR person at all. Blogging is all about authenticity and the individual voice, not paid spin. Many bloggers seem just impedance mismatched with the preternaturally positive PR professionals, and woe to the flack who's busted trying to game Digg without revealing that they're paid to do so.

So now imagine that you're one of those PR professionals. What do you do? Stick with the world you know, and continue calling and emailing releases to the traditional press (trying not to notice that their ranks are shrinking and influence waning)?  Start spamming bloggers, too, and hope for the best? Or just treat alpha bloggers like traditional press and shower them with love, while ignoring the rest?

I've seen all three of those paths taken, some of them even with modest success. Despite the culture mismatch, there certainly are plenty of bloggers who actually don't mind hearing from a PR person, as long as it's in the form of a personal email or comment that reflects that the flack actually reads the blog and gets what it's about. And companies such as Microsoft and Sun are now shifting their PR strategy to give special attention to influential bloggers, inviting them to private briefings and giving them early looks at new products.

But fundamentally social media is a peer-to-peer medium; bloggers would rather hear from someone doing something cool than from the paid promotional representative for that person. The problem is that the people doing that cool stuff are busy, which is why they pay PR people to do the outreach for them in the first place.

Hospital Mortality Rate Study

hospital_2.gifWant to live through your next brush with lab coats? Your chances are much better if you're lucky enough to pIck one of the nation's top hospitals. I wonder how this might extend to cosmetic procedures:

The top 5 percent of hospitals in the United States have a 28 percent lower death rate than other hospitals in the nation, a new study finds...

Over those three years, the top hospitals reduced their death rates by an average of 11.7 percent and reduced post-surgical complication rates by about 3.4 percent.

If all U.S. hospitals had the same quality of care as the top hospitals, 158,264 lives might have been saved and 12,409 major complications avoided, the study authors said.

HealthGrades risk-adjusted the data, to compare on equal footing hospitals that treated sicker patients.

Your local hospital stats are here -- check it out if you dare -- here.
Top U.S. Hospitals Have 28% Lower Mortality Rate: Study

hat tip to: Bodyhack

Dermacare Laser & Skin Care Clinics


The "Dermacare Laser & Skin Care Clinics" logo at one time appeared on this page. Dermacare sent me a nasty cease and desist letter so I've taken it down. You'll have to use your imagination.

 

The post on 'what's wrong with medspa franchises' is usually somewhere near the top of the list of most view posts on medical spa MD. The comments below were made on that thread. I'm reposting them here.

For all intents, these posts are anonymous. On one had I can understand that Dermadoc and Fiona might not want to be identified if they're offering less than flattering comments on a business relationship they're in. On the other handt, they're anonymous. So... DermaDoc and/or Fionna, please contact me through the email link here. I'd very much like to contact you. (I maintain all correspondence in absolute confidence.) Here are the comments:

From DermaDoc 

"I appreciate the opportunity to get a few things out in the open about one of the 'up and coming' MedSpa franchisors - Dermacare.
We have been associated with them for nearly 24 months and have found A LOT of problems, beginning with the 'song and dance' of the franchises being sold at a phenomenal rate because they are so successful. The numbers they disclosed were impressive, but in fact included the Master Region clinics that were under contract to be opened over the next 5 years, not those that were in process currently.
Their Gold Standard procedures were oddly enough only available through one laser manufacturer, Cutera, whose products you are obligated to purchase. I always found it hard to believe that one company can have the state-of-the-art technology for all procedures.
Dealing with corporate is like a revolving door - it takes a long time to get an answer to your question because the person you asked yesterday is already gone and likely took all their notes along with them. It seems as though the majority of the staff is involved in the legal department, which is an eyebrow raiser in itself. Marketing assistance is essentially 'send us money and we'll do it from Scottsdale'. There is a strong sense of denial that marketing in Scottsdale is different than marketing on the East or West Coasts. While they do furnish extensive manuals and background materials for franchisees, a review of the contents shows that it is focused more on what the franchisee must do to avoid having their rights revoked (which has happened to more than one franchisee), than what the franchisor is doing to help create a successful enterprise.
Dermacare does require on-site physician oversight, which I believe is quite valuable to the patients, but they are creating a smoke-and-mirrors image that is leaving a bad taste in the mouths of more than a few of its franchisees.
Thanks for listening to a late night rant!" - DermaDoc

And from Fionna:

"DermaDoc, I worked at a Dermacare facility where there was no physician "on site." I am a midlevel who was there "in place of" the doc. Has something changed in that they now require on-site physician supervision? I find that hard to believe since the physician had his own practice and was off-site most of the time." - Fionna

Ribbon Lift: Another face lift wannabe?

I posted on the Silhoutte Sutures. Now for the Ribbon Lift, another attempt to create a more effective featherlift.

Ribbon Lift just had a story plug on one of the entertainment tonight shows. The ribbon looked as though you'd be able to feel it quite well while it was under the skin. I can't imagine patients (or their husbands) liking that too much. That it's bioabsorabable makes me wonder about the long term results. 3-5 years as a claim seems suspect. Any thoughts or questions are welcome in the comments.

From an ABC story on the Ribbon Lift.

Dr. Gregory Keller has been doing the ribbon lift for about two years now. He starts with an incision right behind the ear.

"We pull the muscle back and then the skin scars back down to the muscle and it's held in place there while it dissolves for about two to three months," Dr. Keller said.

The endotine ribbon device is fashioned with several hooks along its length. It grabs on to the muscle and allows the surgeon to pull up the loose skin.

Pamela is getting four ribbons put in. Dr. Keller says patients usually recover within a week although many have returned to work a lot sooner. He say the procedure has very few side effects that could include bruising. And the results can last anywhere from three to five years.

ribbon-lift-ENDOTINE-Ribbon%E2%84%A2.jpg

To eliminate sagging skin on face, a new procedure called “Ribbon Lift” . The procedure is safe alternative to the current face lift procedures being offered.

Review of Ribbon Lift face lift procedure
a. The Ribbon lift procedure involves making an incision behind the ear and placing a a bioabsorbable ENDOTINE Ribbon™ to hold the muscle back and allow the surgeon to tighten loose skin.
b. The bioabsorabable ribbon which has hooks is dissolved in a period of 2-3 months.
c. The recovery time is maximum a week.
d. It has few side effects like bruising etc.
e. Results last from 3-5 years.