Cool thoughts on body hair.

I love cool science facts.

Research shows that we humans lost all our body hair through evolution about a million years before somebody finally figured out how to purchase clothes at one of the first primitive Walmarts.

One theory says that we lost our all body hair in an attempt to avoid parasites like ticks, fleas, and lice, and that we've only kept the hair on our heads because other people think it's pretty. As proof, consider that you haven't seen many bald pregnant women.

Study: p53, skin cancer, & tanning.

A Protein Twofer That Triggers Tanning and Protects against Skin Cancer

Researchers find that a protein activated to repair DNA damage also activates tanning, which can protect against melanoma. Scientists at Harvard's Dana-Farber Cancer Institute have discovered that p53 not only mends genetic material but also kicks off the chemical cascade that results in tanning.

The researchers report in Cell that when p53 is activated (in response to DNA damage caused by the sun's ultraviolet (UV) rays and other factors), it triggers production of alpha-MSH, a hormone that then prompts production of melanin, or pigment. Recognizing that p53 is the linchpin of this chain of events could result in a way to "give people tans without needing the sun" (or creams or sprays to artificially color their skin), says senior study author David Fisher, director of Dana-Farber's Cutaneous Oncology and Melanoma Program.

Hat tip to Midwest.

Medspa MD Manners: Be nice or be gone.

There's been a disturbing increase in the tone of comments lately.

Disturbing to me at least. Use of all caps. Pejoritive terms like 'Dermboy' used. And lot's of holier than thou lectures.

Certainly I may have prompted at least a little of it since I'm generally free with my opinions, but I'm not interested in running a site where people get shouted down or are hesitant to comment since they might be flamed.

Karen, who posted her displeasure with DermaCares customer service emailed me and asked for her email to be removed. She was honestly fearful that she may be retaliated against in some way. That's not constructive.

So while passions may get inflamed, please keep them in check. Post what you want but try and remain civil.

That being said, the comments are often the best read. But those that I think cross the line may be edited or removed. I constantly have to remove spam comments and references anyway.

Plastic Surgery & Teens.

From Australia: Teens want bigger boobs.

Darryl Hodgkinson, a cosmetic surgeon for 26 years, says he is treating more teenagers now than he did a decade ago — between 3 and 5 per cent of his patients are teenagers.

There are "psychological consequences of having a real physical deformity like a really big, fat bottom". Surgery such as liposuction to remove fat that won't budge with exercise and diet can help adolescents with a negative self-image suffering extreme social distress, he says. His price starts at $5000 and his youngest liposuction patient was 15.

Dr Bruce Fox, a Melbourne cosmetic surgeon of 25 years, operates on about six adolescents a year. Last year he had a patient who was 17. This year he has performed liposuction on an 18-year-old. He says it is not a weight loss technique, but a procedure to correct a body shape that might be "size eight up top and 10 or 12 downstairs".

Retail Anti-Aging Hocus Pocus:There's one born every minute.

Via Medgadget: Water soluble vitamins in your shower head . . . Now really, does this stand a chance of doing anything except liberating some cash from your pocket? The manufacturers claim that this will "reduces skin irritation and rashes", but we suspect a significant placebo effect would be responsible for any such claims. What ever happened to just eating right?

Product Page)

Medspa MD update

I've dropped off the frequency of my posts of late. Of course there's a couple of reasons for that. My daughter brought home a nasty little bug that laid me low with a temp of 105.4 last week, and then there's always other business, personalities, and relationships that need managing.

The comments on the Derm and Dermacare threads have taken on something of a life of their own which is both informative and interesting.

There will be some new authors posting to the front page. I've invited some regular commenters to write more about their medspas and what their up to. We'll see what kind of insights we gain.

There are a number of contacts I have with some of the technology companies. I've been thinking that I should approach them about pitching their technologies here where they can be commented on and questioned in what's as near to a level playing field as anyone can really expect.

Anyway, 1 pm on a Sunday morning. I'm going to bed.

New tan implant from down under.

Via Medgadget: Clinuvel Pharmaceuticals is testing a rice-grain sized implant that when placed under the skin induces a tan and provides increased UV protection.

The dermatology-focused biotech, formerly known as Epitan, had initially marketed its leading drug as a tanning product, saying it produces eumelanin, a pigment which can protect skin from UV exposure.

But under its new name Clinuvel, the company said the same drug, CUV1647, is also a serious clinical treatment for a range of skin conditions.

Clinuvel said those conditions include polymorphous light eruption (PLE) or sun poisoning and actinic keratosis (AK), a skin cancer precursor.

More From Australia's The Age...

Link to Clinuvel...

LS, a Derm that's pissed at Medspa FP's and OB's.

The war to control cosmetic medicine that's been raging between plastic surgeons and dermatologists has a new additon, aesthetic physicians. And here's one derm that doesn't like it.

LS posted this comment on: Botox certification for family Practitioners

"When I graduated from med school, only me and another guy got into a derm residency - and he had a PhD in Immunology before getting into med school. The OB's and FP's were at the bottom of the class. Now they want to get into cosmetic dermatology for the money - but they are NOT TRAINED to do anything with skin. Derm is a 3 year residency - these people know so little they don't have a clue how little they know. Studies have shown that when primary care physicians get minimal (like 4-6 weeks) of Derm training, they begin to see that it's an incredibly complex field of which they know not, and the number of referrals to derms INCREASES - the more training they receive, the more they refer.

The Cosmetic companies and laser companies are all in it for the money so they don't care WHO they sell to. This is all going to change - the policy makers are already working on it so these FP's etc who are going into it better have their own practice of sore throats and earaches to fall back on since the balloon is about to bust."

LS has a point. Dermatology is a specialty.

It's also the study of 'diseases of the skin', not Botox and laser hair removal. Although some medical schools are geting into this, Dermatologists generally get training in cosmetic procedures the same as other doctors... see one, do one, teach one.

Dermatologists are physicians (medical doctors) specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages...

Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there are a wide range of congenital syndromes managed by dermatologists.

 LS is right that Florida has passed legislation, but it's going to be harder to enforce than keeping Paris Hilton at home.

There's also something of a conflict in that dermatologists are trained to treat medical problems like skin cancer. With skin cancer the fastest growing cancer in the US, there's a train or thought that says dermatologists should focus on where they can do the most good, not where they can make the most money. Of course that's not the real world either.

Comments? 

Make sure your plastic surgeon has a Wii.

Study: Surgeons who play video games have got mad skills.

Out of 33 surgeons from Beth Israel Medical Center in New York that participated in the study, the nine doctors who had at some point played video games at least three hours per week made 37 percent fewer errors, performed 27 percent faster, and scored 42 percent better in the test of surgical skills than the 15 surgeons who had never played video games before.

"It was surprising that past commercial video game play was such a strong predictor of advanced surgical skills," said Iowa State University psychology professor Douglas Gentile, one of the study's authors.

How not to handle plastic surgery malpractice pubicity.

My Surgery Nightmare: An unhappy patient takes on her plastic surgeon.

Plastic surgeons are among, if not the most, likely physician objects of malpractice claims. And when patients want to punish you, they now have resouces. Case in point; mysurgerynightmare.com.

The reasoning is simple. Where an unwanted outcome in cardio-thorasic surgery is marked off as a given possibility, people who are looking at plastic surgery don't have the same expectation of risk. Cosmetic treatments are viewed as flawless and doctors often minimize the possibility of an unwanted outcome.

A poor result strikes directly at a patients ego and perception of self. Not something you want to damage and remain friends.The

The level of communication and networking now available on the web gives anyounparalledled access to spreading their views.

From the site:  

***UPDATE: Dr. Sykes tried to force me to take down this website by suing me for defamation. On January 26th, 2007 the California Court of Appeal unanimously ruled that Dr. Sykes' claims had no merit.  The Court found that my website contributed to the public debate regarding plastic surgery.  The Court also said that the statements on my website regarding Dr. Sykes were either true or were matters of opinion.  It said Dr. Sykes was unable to show that there was any false information on this website.  Since the Court of Appeal ruled in my favor, Dr. Sykes and his attorney have continued claiming that my website is misleading.  But the Court considered and rejected all of their arguments.

And there's this:

In a sworn deposition on October 26, 2004 it was asked of Dr. Sykes if he's ever been a defendant in any other medical malpractice lawsuits.  His answer was "I think three others."

The fact is Dr. Jonathan Sykes has  MANY medical malpractice lawsuits filed against him.

Medical malpractice lawsuits* were filed against Dr. Sykes on  9/9/2005 ,  7/21/2005,  4/12/2005,  7/12/04,  5/25/2004,  12/01/2003, 12/11/2002,  4/15/2002,  12/12/2001,  8/18/2000 and 11/14/1991.

 Does Dr. Sykes really want eveyone to know that he was sued three seperate times in 2005?

Certainly there is widespread distain for all things legal among physicians. Just take a look over at Kevin MD where there's continual back and forth among docs and malpractice attorneys. 

Part of the problem is the inherent conflict of interest in plastic surgery and other elective procedures. Where a doc in an ER is not choosing patients and is generally on salary, a cosmetic plastic surgeon is performing and elective procedure and benefiting directly from the payment.

Ah, there's the rub.

States taxing plastic surgery & cosmetic medicine.

From the Denver Post: MN to tax plastic surgery

State Rep. Phyllis Kahn is pushing to extend Minnesota's 6.5 percent sales tax to include cosmetic surgery and appearance-enhancing procedures including chemical skin peels, laser hair removal, cosmetic injections and spider vein treatments.

Anybody who has the money for plastic surgery can afford to pay the tax, said Kahn, a Minneapolis Democrat.

"There aren't a lot of homeless people and there aren't a lot of people who don't have enough money for food who are getting optional cosmetic surgery," she said.

New Jersey is the only state that taxes cosmetic surgery, collecting an estimated $11 million this year. Kahn said her proposal would raise about $7 million a year.

Most of that money would come from the bank accounts of hardworking women, said Dr. Richard D'Amico, president-elect of the American Society of Plastic Surgeons. He said 90 percent of plastic surgery patients are female, with annual incomes averaging about $60,000

Dermacare Medical Spa Franchises Unite?

 Just when I thought I was out of the Dermacare saga...

I had an interesting weekend. I spent a fair amount of it talking to and exchanging emails with unhappy Dermacare medical spa franchises. Sheesh... It's a hornets nest. One of the Dermacare owners sent me this email from Carl Mudd, Dermacare's CEO: 

From: Carl Mudd [mailto: Carl@DermacareUSA.net]
Sent: Monday, February 05, 2007 6:54 PM
To: Carl Mudd
Subject: Blog email

To All Franchisees:

   I wanted to make everyone aware of this press we are getting in this public chat space. This type of thing hurts all of us and takes money from the pockets of all franchisee's as this is clearly available to the entire public.

   Perhaps those of you who find this type of thing offensive could respond appropriately.

/the-blog/2007/1/22/dermacare-laser-skin-care-clinics.html

Carl Mudd

CEO/ President
Dermacare Laser & Skin Care Clinics(R)
DLC Dermacare LLC
4835 E. Cactus Rd. Suite 345
Scottsdale , AZ 85254
(602) 424-0788 Phone
(602) 424-0811 Fax
(877) 700-0788 Toll Free
www.DermacareUSA.com
Carl@dermacareusa.com

Offensive? It seems that there's much unrest in Dermacare land.

The first two years of owning a franchise are historically the 'honeymoon period' in which the franchisor offers the most support and training. Franchisees tend to get more unhappy as time goes by since the franchisor has less to offer. The trouble with a franchise as young as Dermacare does not bode well.

First, while I was not a recipient of Mr. Mudds email, his reference to 'offensive' makes me think I should make my position know lest you a think I've got a history with Dermacare.

Mr. Mudd says that this is taking money out of all Dermacares franchisees pockets. Ehh?

The real problem for Dermacare and Mr. Mudd is not potential Dermacare patients who might stumble across this site, it's the physicians who are reading and may have second thoughts about getting involved with a business in which the franchisees are terrified that Dermacare will find out who they are... and the existing Dermacare franchises who now have a place to post their opinions in a group without having to remain in isolation.

Since DermaDoc first started commenting I've received three other direct contact (by phone or email) from Dermacare franchise owners. While I still don't know who DermaDoc is, I now know some others... and they're even less happy than DermaDoc. I've been sworn to secrecy but suffice it to say that there's trouble brewing. I don't have much experience with Dermacare (other than their threatening letters) but the owners seem to think that it's run by the Sopranos and if anyone finds out they've talked Paulie Wallnuts will be by to wack'em. 

Here's the consensus from the four contacts I've received (Three owners and one in 'corporate'.)

• No one is happy with Dermacares corporate support. It sounds errily like Ron's experience with Sona.
  
• Dermacare's turnover at headquarters must be tremendous. Three of the four mentioned that they're constantly working with new people who they don't know. 
  
• They're ecstatic that this site exists and that there's a venue where they can air their grevences without being identified and targeted for cement shoes.
  
• They don't want to say what they really think since they're already in Dermacare's boat and don't want to sink it underneath them.

 So I'm going to post a new thread for discussing medical spa franchises. If you're an owner or medical director, please feel free to comment or contribute. If you're one of the owners who Mr. Mudd feels should be running to Dermacares defense or feel that this site's 'offensive', we're happy to hear from you too.

So, while I'll occasionally mention Dermacare, Sona, Sleek, American Laser Clinics, Solana, Solara, and whoever, it's up to you as individual readers to draw conclusions.

Dermacare, Sona, American Laser Centers, & the rest.

We'll, since I posted that Dermacare sent Medical Spa MD a cease and desist letterthere's been a flury of activity with Dermacare franchise owners commenting and emailing me.

DermaDoc comments: "Just checking to see if anyone has heard from any other of my fellow Dermacare franchisees? News about this blog is circulating around the organization but in somewhat hushed tones, presumably to not incur the wrath of the corporate behemoth. We'll keep watching."

Actually, I've received a couple of emails. I'm surprised to see how clandestine this has become. Evidently all the owners feel that Dermacare would retaliate in some way if they were able to be identified.

It's not my intention to do a hatchet job on anyone. Certainly, there are Dermacare, Sona, American Laser Clinic, Inaara, Solara, Sleek, and other medspa franchise owners who are among the most active readers and contributers to this site. 

But, in my opinion, the current batch of  franchisee medical spas and laser clinics have serious flaws for both physicians and consumers. Of course some medspa franchises are worse than others, but I'm not a big fan of any of the current systems. Perhaps they'll change. Perhaps they'll win me over. Certainly it's obvious to those who do comment that I'm not editing them in any way. If there is anyone who's a big proponent of any medspa franchise, I'm happy for them to comment and explain their position and detail their benefits.

Of course, I've asked for happy medspa franchise owners to comment before... So far no takers. Not one. From the hundreds and hundreds of comments on this site, there's never been one glowing review from a happy medspa franchise owner. The silence is deafening.

Of course there's sometimes manipulation. I posted a poll on Does Thermage work on this site and know (I can see IP addresses) that there were Thermage reps who cast a large number of positive votes. (I'm going to redo that poll along with others which will make it harder to cheat.)

Just wanted to be clear since I know that Dermacare, ALC, Sona and the rest are reading this blog, let's hear from some happy medspa franchise owners. Comon' guys, here's your chance. Let's hear something along the lines of Midwest's comments about this site on the post from that Dermacare letter.

 Here's some snippets... (This makes me blush.)

" Oh sweet medicalspamd...you are the Angie's List of the cosmetic industry!"
"Thank God I have you as a resource medicalspamd."
"Viva MedicalSpaMd..."

See, Let's hear that from a medspa franchise owner. And no, Midwest is not my mom. 

Would you buy a Medical Spa MD book?

Hmmm.... In the last month I've received six unsolicited emails inquiring about or suggesting that I write a guide or ebook about opening a medical spa and/or medspa operations.

When I started Medical Spa MD (at the time it was Medical Spas Online), my intent was to educate physicians who I saw making the same mistakes over and over and had no real sense of what was happening outside their own clinic. I thought I'd make a site and share some of the things I've learned in running and growing Surface. This site will pass 10,000 unique readers from around the world this month and the community is educated and informed.

So, here's a question with the two poll on the right. Would you buy a book from this site?

Easy. Let's do some market research here. This is completely informal of course and I'm just trying to get a sense of if it's worth the effort.

Medical Spa Franchises & Non-Compete Agreements.

Since Dermacare send me a cease and desist letter, there have been a number of supportive comments from readers. Dermacare is not the first or only medical spa franchise who might not like what I've written. Ron's probably not on the Christmas card list for writing his series on Sona; Inside a medical spa franchise.

During our email conversations, Ron has expressed surprise that no other medical spa franchisees have really stepped forward to share their experiences. There's two possible explanations for this; all the medspa franchisees are really happy... or, those who are involved with the current crop of medical spa franchisees are 'concerned' about rocking the boat they're sitting in. Physicians are also know for the being terrified of lawyers and inherently resistant to change. You'll have to make your own decision on that but I'd invite Dermadoc, Ron, Midwest, and anyone else with experiences either way to comment. (I'd also like to hear from physicians who've investigated Sona, Radiance, American Laser Clinic, Solara, or other medical spa franchise to comment on what they found and why they decided not to buy.

Here's an Anonymous comment from the post on Dermacare's cease and desist letter.

I'm enjoying reading this blog. It gives a clear picture of what is actually occurring in our neck of the woods. I'm a franchise owner as well, and have found the start-up to be an incredible journey, but not always fun. Here are my observations thus far:

The franchise I am with, has been very helpful for the most part. I do have a problem with all the energy and money expended to ensure that the corporate name is not "tarnished" however. I have a 10 year contract with no out clause. So should I decide at some time in the future that i no longer want to be a part of the franchise the only way i can do that is by selling my practice. Then I have a restrictive covenant that forbids me from practicing cosmetic medicine anywhere else. I am also restricted in what procedures I can perform in my franchise. The last time I looked, I have an UNRESTRICTED LISENCE to practice medicine. I'm not sure if these non-competes will hold up in court, but, I do know one thing. The franchise will do everything in their power to enforce it. And that i have a problem with.

And here's another comment from What's wrong with medical spa franchises & medspa consultants.

Thank you for these posts. As a franchisee, just starting my clinic, I have spent many a sleepless night worrying how I will succeed in an ever increasing competetive market. When you get right down to it, selling laser cosmetics is nothing more than selling TV sets or cameras. Some companies will thrive, others won't. Up until now, medical cosmetics has been the domain of plastic surgeons and dermatologists. However, in the past few years we're witnessing a whole new realm. And the sharks with MBA's have found a new breeding pool: MD's disatisfied with their current medical practice. They blindside unsuspecting doctors with promises of riches and offer examples of fellow physicians who have prospered. What is not being told are the risks involved, the difficulty of actually opening up a clinic, the costs and the failures along the way.
I, for one, have extended myself far beyond my comfort level. I've trusted those who smile to my face and tell me that they have my best interest in mind, but underneath have scales and circle the tank for any signs of blood or weakness. They expect that I have no business experience and they are correct. I can bring back life to dying infant, but ask me to balance a ledger and I have no clue.
I am their pray and fodder.
Time will tell if I ever get up and running. But, I caution my fellow physicians to be very weary of the sharks and do you're due diligence

About Medical Spa Franchise Non-Compete Clauses 

 
Any lawyers out there? Anonymous is right in that it's probably not enforceable in the medical sense. It may well be entirely enforceable for that location in a business sense. This is often not a problem for a restaurant franchise, but if you're a physician, you might want to think long and hard about what you're getting intomedspamedspa franchise will tell you that this is all 'standard' and 'boilerplate' language and that it's required. It's not. (I did extensive research on franchising when I was investigating offering a Surface franchise.)

Giving you a UFOC is required, a waiting period to accept payment is required, what the franchise agreement says is not required. It's a contract between you and a medspa franchise and is open to negotiation in the same way that any agreement is. Ten years of your life is a lot to sign away. Franchises typically start to have problems after the second year, when the gloss of promises starts to wear thin and the doc starts wondering what they're paying for.

The reason that medical spa franchises give to physicians for this kind of 'buy in' and term is that the costs to the franchise are all up front and that the local name recognition is so valuable that they can charge for it. Read the posts on medical spa franchises and a different picture emerges. 

If you're in a position to have an opinion, please comment, but pick a name... and not Anonymous. If you're willing, on the comments form put your medical spas web address (http://www.medicalspa-whatever.com) so we can see who you are. Of course, if you fear retribution from the medical spa powers, no link is necessary.

New Medspa? First; Write your press release.

My friend Pete loves to spread the word about customer obsession. Change the word 'customer' to 'patient' and Pete's blog is entirely applicable to your medical spa operations, even if it's distilled to equations.

One of Shmulas posts has to do with his experiance working at Amazon and the customer obsession that was practiced there. Here's an excerpt from Petes post on starting at the end and working back for clarity. Write the press release that announces where you're going to be first.

From Pete's blog at Shmula: Here’s another example: the product development process at Amazon is centered on the customer.  Amazon follows a process called "Working Backwards", which means that the first deliverables created are the documents at  launch, then work backwards towards the items closer to the implementation.  Defining a product this way adds clarity and simplicity — you know at the front-end what the customer can expect, and working backwards allows the team to build it.  Here are the general steps followed in this process, and I take it directly from Werner Vogels:

1. Start by writing the Press Release.  Nail it. The press release describes in a simple way what the product does and why it exists - what are the features and benefits. It needs to be very clear and to the point. Writing a press release up front clarifies how the world will see the product - not just how we think about it internally.
2. Write a Frequently Asked Questions document. Here’s where we add meat to the skeleton provided by the press release. It includes questions that came up when we wrote the press release. You would include questions that other folks asked when you shared the press release and you include questions that define what the product is good for. You put yourself in the shoes of someone using the product and consider all the questions you would have.
3. Define the customer experience. Describe in precise detail the customer experience for the different things a customer might do with the product. For products with a user interface, we would build mock ups of each screen that the customer uses. For web services, we write use cases, including code snippets, which describe ways you can imagine people using the product. The goal here is to tell stories of how a customer is solving their problems using the product.
4. Write the User Manual. The user manual is what a customer will use to really find out about what the product is and how they will use it. The user manual typically has three sections, concepts, how-to, and reference, which between them tell the customer everything they need to know to use the product. For products with more than one kind of user, we write more than one user manual.