Opening a medspa? MD thinks lasers may be to big a leap.

MDmd is thinking that opening a medical spa or laser center may be more than he wants to bite into.

MDmd says: "I have been off the internet for a while, and wow, I've missed some interesting stuff here! LH, thank you for taking the time to post a thoughtful and helpful response to my question. It seemed obvious to me that you speak from experience, and that you are an open and honest person who is kind enough to share your knowledge. (Same goes for Dexter.) I have found this site very helpful for the reasons Jeff lays out.

In any case, I have gained enough insight here to know that I am not going to venture into the world of lasers. It's too big of a risk for me. Thank you to Jeff and the contributors to this site, who have opened my eyes to the realities and pitfalls of this business."

It's true that while there are many pitfalls and that there are sharks ready and willing to take your money, it's certainly not all bad. It's a difficult decision and not for everyone but I have yet to see a situation where a well run clinic that is setup correctly doesn't succeed and a physician who enters the market and has some success, doesn't want more. The market is growing fast and  that creates conditions where even poorly run clinics can squeeze by.

But, unless you're committed to it I'd guess that you're making the right decision. Of course you should keep an open mind and perhaps change it later when your comfort level is greater. This site offers a wealth of experience and insight. Sure, it's the troubles and assholes that get the majority of attention but there are plenty of success stories as well.

The smartest think you're doing is taking a step back and not rushing in. There's plenty of time to make a decision later. 

Medical Slang: How doctors insult their patients and each other.

The terms by which physicians insult patients and each other.

 
More insulting terms for patients, diagnosis, and general physician slang.

Terms for physicians:

 

• Acades vulgaris - medical students.
• Adminisphere - where hospital managers work, reckoned to be "another planet"
• Ax(e) - surgeon
• Blade - Surgeon: dashing, bold, arrogant and often wrong, but never in doubt
• Blood Suckers - those who take blood samples, e.g. lab techs
• Bones and Groans - non-specialist general hospital
• BoneHo - an off-service resident working in Orthopedics
• C&T Ward - Coma ward - "cabbages and turnips"
• C_nts and Runts - Maternity and Paediatrics
• Captain Kangaroo - head of a paediatrics department
• Freud Squad - psychiatry department
• Gasser, gas passer, gas man, Gaswallah - anaesthetist
• Slasher - surgeon
• Short-order chef - morgue worker
• Knuckledragger - orthopedist
• Overpriced Carpenter - orthopedist
• Orthopod - orthopedist
• Flea - internal medicine doctor
• Humpty-dumpty doctor - a physiatrist or rehabilitation physician; referring to verse from the popular nursery rhyme that "all the king's horses and all the king's men could not put humpty together again."
• Stream team - the urology service collectively
• Pecker checker / Cock Doc- urologist
• Pediatron - paediatrician
• Baby catcher - obstetrician
• Rear Admiral - proctologist
• Unclear medicine - nuclear medicine
• BoneHo - off-service resident working on Orthopedic service
• Osteopath - D.O., Doctor of Osteopathy--a physician licenced to practice medicine and surgery who is trained in osteopathic medicine
• Hearts and Farts - unit specialising in geriatrics and cardiology
• Inbreds - doctors whose parents are also doctors
• Larry - Locum, as in "doing a Larry"
• Raisin Farm - old person's home, geriatric ward etc (also Raisin Farmer - person who runs old persons' home)
• Removal men - dept of care of elderly people
• Rheumaholiday - rheumatology (considered by hard-pressed juniors to be a less busy dept)
• Shadow gazer - radiologist
• Sieve - a doctor who admits almost every patient he sees
• Cath Jockey - A cardiologist that catheterizes every patient they see. Or one that does cardiac catherizations.

Hey, I didn't make these up. Many are not even included due to good taste.If you have been insulted by a medical proffesional speak to Alexander Harris and find out more about clinical negligence.

Dermacare Laser Clinics: Inside info.

Dermacare is having it's big meeting this weekend as I understand...

 
with more than 200 comment on the other Dermacare posts: Dermacare Laser & Skin Care Clinics and Dermacare Management: Carl Mudd & the lawyer, it's getting crowded over there.  Dermadoc, Double Dermadare, Dermacareless and other franchise's have already commented that they're going to post their thoughts on this event. I was emailed with the helpful idea that I should offer this event it's own thread from DD, DCL, and DDYs fan club, so here it is... I'll be that Carl Mudd is on his best behavior.  Hope there's no blood shed.

Palomar selling to overseas day spas and hair salons.

The legal aspects of opening and operating medical spas or nonsurgical centers comes up a lot.

In general it's up to individual states to decide what is or isn't a medical treatment and who can or can not operate medical devices. It's obvious from past history that medical device manufacturers would like to be deemed medical, but not operate as though they were. I guess spas and salons love to offer medical treatments. (Perhaps oversees it's not medical)

This comes directly from Palomar's web site on International Distribution Opportunities:

...seeking qualified international distributors for our laser/pulsed-light cosmetic devices into the doctor and spa/salon markets. To qualify, your organization must offer sales, service and marketing support. In addition you must have a presence in the medical and/or spa/salon markets.

I don't really blame Palomar for selling regulated devices into the third world. They're just trying to balance the trade deficit.  Not really a criticism, just an observation.

Medspa MD: Contacting others by email.

At some time you may want to ask a question of someone who has commented on this site.

If the commenter has entered an email when they posted, you can use this site to send an email. The person contacted will receive an email from this site and can choose to reply or not. They (the person being contacted) will be able to see your email. You (the person sending the email) will not be able to see theirs. I've used this system to avoid troubles like spam bots scraping emails or personal attacks.

So to be clear, if you wish to be able to be contacted, just leave your email when you comment. Your email will never be made public but other will be able to contact you.

NOTE: Solicitations or complaints will be immediately removed and offenders will be blocked from accessing the site. If you're really bad you may elicit a post. Here's Medspa MD's spam and solicitation policy. 

To send an email through Medspa MD: 

• Click on the name of the person you want to contact.

• If they have entered an email: Click the 'Send Email' button.

That's it. It's completely at your own discretion as to whether you'd like to leave an email.

Remember: Be nice, or be gone. 

Medical Spa MD: Is this the premier medspa site on the web?

Having been posting to this site for a couple of years now, I'm going to take a stab and declare that I think that this site is the best medical spa site on the web.

I've been increasingly impressed with the community here and can only see it increasing in both quantity and quality. As an example I hold out this exchange where miss beauty questions 'this person LH'. The responses are thoughtful, semi-funny, and more importantly, educational. Dermadoc, Dermgal, MDmd, VexedMD, ChicagoMD, Dexter, Medpsa MD, SWMD, yada, yada, yada.... you get the idea. Even patients have added.

There are some other sites and certainly there are a number of other physician blogs (mostly plastic surgeons) who are in this area, but I think they're different. 

I'd hazard a guess that 80% of everyone who has signed up as a Medical Spa MD member is a doc. 10% seem to be midlevel providers and the rest identify themselves as something else. With 18,000 unique visitors a month, that's a lot of docs who are reading the site.

Of course there are others who think this blog is a blight and probably wouldn't lament my passing if I were hit by a truck crossing the street. Dermacare, Radiance, Sona, and the rest of the medspa franchises to be sure. I can't think of any individuals off the top of my head but that might just be wishful thinking.

I'll happily express my gratitude to the community here. Certainly I've learned from everyone and made more than one decision based on what I've read and learned. Thanks to everyone who shares.

Am I right? Is Medspa MD the best site in this area or do I have my thumb up my own ass?

Let's take a poll.

Update on 2007-05-19 14:44 by Medical Spa MD

This poll has been configured to prevent multiple votes. You'll only be able to vote once. My apologies to both promoters and detractors.

Medical Blogs: Kevin MD calls it Black Wednesday.

Via Kevin MD: Grim news pervades the medical blogosphere today.

Fat Doctor has announced she is shutting down her blog:

Someone in my department printed out my blog and showed it to my boss. He tells me he didn't read it and won't interfere in what I do with my own time as long as I do a good job at work.

Flea's blog mysteriously vanished. Perhaps not coincidentally, he is in the midst of a malpractice trial.

Last year, Barbados Butterfly was forced to shut her blog after her hospital found out:

Physician Consultations: The paradox of unlimited choices.

While not the best dressed presentation, Barry Schwartz's presentation on choice is worth watching for anyone designing an offering or performing consultations.

 
Via Presentation Zen:

Happiness, decisions, & the paradox of unlimited choices

 If some choice is better than no choice, and more choice is even better than that, then how can still even more choice — a seemingly unlimited array of choices in fact — not be a kind of decision-making nirvana where people make both better decisions and are happier about those decisions? Do not more choices and a greater number of options lead to better decisions? And if so, why then are people unhappy with their decisions even when a decision is a good one? Why do people feel regret even when they choose well?...

Learning to love constraints
 At the end of the book Schwartz ends with 11 ways we can end the crippling effect of too much choice or  “the tyranny of small decisions.” The last one in the list is simply this: “Learn to love constraints.” I recommend the book, but you can save your money and get a pretty good feel for the book’s content by watching this 2005 presentation by Barry Schwartz at TED (below). This is a good presentation, though you will surely have some tips to offer him on both slide design and on the issue of making appropriate fashion choices on the day of your presentation.

“Imagine finding yourself lost on the open road. You finally see a lone gas station up ahead, you’re hungry to discover the route back to the freeway. You ask the attendant for directions, and he begins to offer plan A and plan B and plan C, each with varying degrees of specific detail. Rather than finding the clear, simple, and concise directions you were seeking, your brain is now swimming in a sea of even greater confusion. Clear, simple, and concise directions are all that you want.”

We've all had a similar feeling while using a poorly-designed website, application, or even a cell phone that did everything under the sun except make calls that didn't drop halfway through a conversation.

Simple, clear, concise
As daily life becomes even more complex, and the options and choices continue to mount, making designs which are clear, simple, and concise becomes all the more important. Clarity and simplicity — often this is all people want or need, yet it’s increasingly rare (and all the more appreciated when it’s discovered). You want to surprise people? You want to exceed their expectations? Then consider making it beautiful, simple, clear…and great. The “greatness” may just be found in what was left out, not in what was left in.

Skin Cancer & Photodynamic Therapy

Via Wired: Making Skin Cancer Therapy As Convienient As A Band-Aid

A new light-activated therapy could make skin cancer treatment painless, inexpensive and portable.

Scottish company Lumicure has developed a portable device that combines a tiny light, a photosensitizing cream and a bandage that, if approved by the Food and Drug Administration, could treat skin cancer conveniently with molecular precision.

"It can be worn by the patient in a (Band-Aid), while the battery is carried like an iPod," said professor Ifor Samuel of the Organic Semiconductor Centre at Scotland's University of St. Andrews, who helped develop the technology, in a statement.

Skin cancer, which typically requires painful or invasive treatments, affects 40 percent of all Americans at some point during their lives. The Lumicure treatment would cost between $200 and $300, compared with roughly $15,000 to $20,000 for the standard therapy. It could also eliminate the need for chemotherapy in some cases.

Lumicure's treatment is a new twist on an existing treatment called photodynamic therapy. It starts with a cream containing aminolevulinic acid, which becomes photosensitive when it comes in contact with a cancer lesion. When exposed to light, the cream interacts with only the cancerous cells, making it a very selective skin treatment.

Lumicure's light source is a low-powered organic light-emitting diode embedded in a small adhesive device. Its battery module -- roughly the size of an MP3 player -- fits easily in a pocket.

Photodynamic therapy available today requires treatment at a hospital using heavy equipment. It's also uncomfortable for patients because they must stay very still under extremely intense light; the treatment also can leave painful skin lesions. The new treatment takes longer than the standard therapy, but there's almost no discomfort and no scarring.

"As traditional photodynamic therapy is delivered in a physician's office, this new technology, if proven effective in clinical trials, may offer the possibility of increased access and ease of use for many patients," said Dr. Isaac Neuhaus, assistant professor at University of California at San Francisco Dermatologic Surgery and Laser Center.

Early human trial results are promising, and Lumicure hopes the light therapy will be available in about two years. Future iterations could target other skin problems including warts, acne and even wrinkles.

Hmmm. This sounds promising. We do a fair number of photodynamic treatments and I've had a few myself to get rid of some ACs and Rosacea. I'd wear another iPod for a while. 

Concierge Medicine Blog: Housecalls & cell phones.

Starting a concierge medical practice? So's Conciergedoc.

Of course he's less than thrilled with the thought of doing laser hair removal as this post attests:

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...

At least I can say I'm practicing what I wanted to my entire life, what I trained for my entire life. I wonder how the "ethics" talking heads would answer this question?

Reactivated Thermage Tips: Thermage responds to supposed study.

Thermage's response to physicians purchasing reactivated tips from abroad.

 
Clint Carnell, VP of Thermage, asked me to post Thermages position on reactivating tips. I have posted it in it's entirety and have added an addendum to the previous post on the supposed study in question.

You'll notice that Clint asks me to remove the post to that study. I've exchanged a number of emails with Clint and he's agreed that the best course of action for Thermage to take will be to have this connected to reactivation post. The study in question is posted a number of times on the web and since this site is likely the first stop, it's also Thermages best option to position a counterpoint where someone searching for reactivated Thermage tips will be exposed to Thermage's position and opinion.

Thermage's position on the supposed study for reactivating Thermage tips: 

I am Vice President of Domestic Sales for Thermage, Inc. 

On your Medical Spa MD web page your blog entitled “Study: Safety & Performance of Reactivated Thermage Thermacool Tips,” gives a summary of a study which allegedly investigated the safety and performance of reactivated Thermage treatment tips, as well as a link to the study publication.  The publication claims Thermage treatment tips can safely withstand 50,000 shots.   

  We have strong reasons to believe the study referred to in the publication never occurred, and that it is a pure fabrication being made by a non-US company to promote their product.  Overusing our treatment tips as suggested by the publication will burn patients. 

We have strong reasons to believe the study referred to in the publication never occurred, and that it is a pure fabrication being made by a non-US company to promote their product.  Overusing our treatment tips as suggested by the publication will burn patients.  

We have conducted a thorough investigation.  We have been unable to locate the supposed author of this study and publication, Michael Stevens M.D., where the study was conducted, any documentation associated with the study other than the study publication, or any of the patients or “experts” who participated in or are referenced in the publication.   

In addition, the data reported by the study is inherently unbelievable.  The study purports to have treated 2,400 patients over a twelve month period (see under “Results” line 1, 1200 patients were treated with reactivated tips, and nine paragraphs earlier reference is made to an equal size control group).  In this industry this would be an enormously large and expensive study (200 patients a month for a year).  Though not impossible to do, it is highly unlikely such a large study occurred (and no one would have heard of it or anyone who was involved in it) given the significant costs and logistics it would require.  For comparison, the largest study we know of involving Thermage is a four year study conducted by Weiss,1 and it only involved 600 patients or one quarter the number Stevens alleges.  In addition, the claims in the Stevens publication are also wildly inconsistent with immense quantities of Thermage quality and reliability data we have compiled on our own products over the years.  We know for a fact the dielectric membrane on our treatment tip will break down when subjected to a tiny fraction of the repeated use this publication alleges can be done.  Dielectric breakdown can result in patient harm.   

So not only does summarizing or republishing a bogus study spread falsehoods, in this case it can endanger patients as well.  The very nature of this study falsely implies that it is a structured, documented and well accepted article.  In fact it is not and the potential use of this study by either a physician and/or patient could lead to poor decision making and patient harm.  We believe it’s in both our best interests to provide the best information possible in order to minimize potential patient complications.  So we ask that you delete your summary blog and link to this publication. 

Of course if you know of any collaborating evidence of any kind supporting either the fact that this study ever happened or the veracity of any of the data or claims made in this publication, we would be very interested in reviewing it.   

We thank you for your cooperation. 

Very truly yours,

Clint Carnell

Vice President of US Sales

1  Weiss, R.A. et. al. Monopolar Radiofrequency Facial Tightening: A Retrospective Analysis of Efficacy and Safety in Over 600 Treatments.  Journal of Drugs in Dermatology – Vol. 5; Issue 8; 707-712; September 2006.

Ideal Image: Another medspa franchise.

From Landscaping to Laser Hair Removal CEO

Last year, Dean Akers was snow skiing and running a small landscaping firm. Then he found an ideal situation.

Now, as the new CEO at privately held Ideal Image in Tampa, Akers believes he's the man to make a laser hair removal franchise development company a $300-million baby in scant time.

Akers, a corporate vet and Bay area lifer, became CEO in October and inherited a goal of 20 clinics within a fiscal year.

But Akers has taken that plan and more than doubled it. He wants 50 locations open by this time next year.

Annualized sales could be in the $75-million to $100-million range, and Akers' goal is to have 180 locations scattered nationally in key markets in three years with total franchise sales in the $250-million to $300-million range.

  A franchisee's investment is likely $500,000 for a turnkey operation that includes the lasers, office furniture and advertising. But now that Akers is steering the operation, the franchisees must have the proven wherewithal to open fast and in some cases open more than one location fast. 

Those are some hairy goals for a company that in 2001 had just $44,000 in sales.

But things are moving. Franchises were just inked for as many as eight locations in Las Vegas, four more in Atlanta and operations in Phoenix; Raleigh, N.C.; Boise, Idaho; and Knoxville, Tenn. Eight locations are running now in Tampa, Lakeland, Sarasota, Miami, Jacksonville, Boca Raton and Atlanta, and in February the concept opens in New Tampa, Palm Harbor, Charlotte, N.C., and Sydney, Australia.

A laser beam of opportunity

When Akers took over, the plan had ambition but lacked cohesive direction. Franchises and territories were being sold fast and stores were opening, but they were a patchwork of inconsistent arrangements.

With Akers on board, that's all changed. If his strategies work, Ideal Image could become a Bay area model of smooth profits and maybe an IPO candidate.

First, Akers brought the vision of being big. "We needed some rules," he said.

Often franchisees take the entrepreneurial spirit and run with it, so much so that they are prone to making independent decisions, he said.

"They get on board and immediately want to change the recipe," Akers said.

A franchisee's investment is likely $500,000 for a turnkey operation that includes the lasers, office furniture and advertising. But now that Akers is steering the operation, the franchisees must have the proven wherewithal to open fast and in some cases open more than one location fast.

"That means capital and horsepower," Akers said.

Would-be franchisees are brought to Tampa and extensively interviewed. One candidate had the money, but it wasn't a right fit.

Since it's illegal for franchisers to tell franchisees what returns will be (See footnote), Akers acts as a sounding board for each franchisee as it navigates the business planning. He asks tough questions about their budgets so they arrive at their own conclusions, he said.

The parent company provides a template of the potential costs.

"They plug in their numbers, and I'll see that they are not putting the right stuff in and I'll ask more questions," he said. "I serve to validate their business model."

The parent company has also created other safeguards for itself. It has a buyback provision should the company decide to go public.

Franchise relations now

Akers created a "franchise concierge" service as part of an overall philosophy of communication at the company.

Internally, he began a program called "circles of success," in which he created a circular organizational chart that encourages interaction among all staff. There were often long staff meetings where much of what was being discussed was irrelevant for a portion of the staff, Akers said.

By asking questions, listening and responding to needs, the company is making an investment in franchisee-relations that history has proven can easily sour.

End. 

 "Since it's illegal for franchisers to tell franchisees what returns will be..."

Kinda.... Franchisors can not say what potential returns look like for franchiees unless they disclose all the actual numbers of current and former franchisees. It's a nuance but important. If a franchisor tells you that they can't talk about numbers their right... They can't talk about numbers unless they actually disclose them. This regulation is designed to keep the "wow' factor to a minimum but it's often used as a way for franchisors to avoid the issue. They'll give you the 'I can't disclose that because it's against the law' spiel but give you the wink, wink - knudge, knudge at the same time.

In fact they can choose to disclose the numbers but they have to disclose the bad ones as well. If you're numbers don't look good you go for the 'I can't tell' model. 

Thermage tackes it's safety reputation among physicians.

This post was written for Medical Spa MD by Thermage.

Thermage Safety - The whole story

Clint Carnell, Thermage, VP Domestic Sales 

 
In reply to your recent blog entitled “Thermage: Do plastic surgeons hate everything non-surgical?”  I am Vice President of Domestic Sales for Thermage:

Much is written about the risks of Thermage, in particular the risk of fat atrophy and surface irregularities referred to in your blog.  Though there were some initial infrequent reports of such effects associated with Thermage after its product was released in 2002, the simple fact is that today Thermage is an extremely safe procedure, and has been so for several years. 

Thermage invented the concept of using non-invasive radio frequency energy for tissue tightening and contouring.  Thermage launched its first product in late 2002.  Though the overwhelming majority of initial treatments were problem free, fat atrophy and surface irregularities were reported in 0.23% of the procedures (2.3 per 1000 patients) in 2002-2003. 

Thermage’s investigation revealed that 100% of the early reports were from 6% of its physician practitioners. 

Our investigation also revealed the cause was over treatment – using excessively high energy settings.  If relatively high treatment settings are used, it is possible to overheat deeper tissue, especially in thin-skinned individuals.  The use of nerve blocks, tumescent anesthesia, and/or intravenous sedation that completely blocked patient pain perception and feedback was also found to be a contributing factor. 

In response to these findings, in January-February 2004, Thermage launched an aggressive physician education program instructing physicians to adopt treatment techniques to avoid tissue overheating.  The techniques included: 

1. Use of a treatment grid to avoid pulse stacking.
   
   
2. Use of multiple passes at moderate power settings rather than single passes at higher energy settings.
   
   
3. Allow 2 minutes between passes to allow temperature reequilibration.
   
   
4. Use patient feedback of heat sensation, and treat to a heat sensation level of 2-2.5 on a scale of 0-4 (4 being maximum sensation).
   
   
5. Use minimal pain blocking.
   
   
6. Pay special attention to patient feedback while treating thin-skinned areas. 

As reported by Narins (1), these new treatment techniques proved to be immensely successful.  During the 6 months following their introduction, the reported incidence of fat atrophy and surface irregularities decreased by a factor of roughly 6 (to 0.04%), and there were no reported incidents in the last half of 2004.  This improving trend has continued to the present.  For example, the reported incidence of fat atrophy and surface irregularities for all of 2006 was 0.016% (less than 2 cases in 10,000).  A similar dramatic decline in all other reported adverse events (e.g., burns, welts, swelling/edema, etc.) has also been observed.  Today, Thermage is an extremely safe procedure. 

In addition to significantly increasing patient safety, the new treatment guidelines have also significantly reduced the discomfort of treatment, since physicians now treat to a very tolerable heat sensation level of 2-2.5. 

Finally, the new treatment guidelines, in particular the use of multiple passes at moderate settings, have also significantly increased efficacy from that reported initially in 2002-2003.  Several peer-reviewed studies show Thermage patient satisfaction to be higher than 80%, and continuing to improve over time.2,3,4  Thermage results are most notably perceptible when it comes to an eyebrow lift or softening of the nasolabial fold, and provide a remarkably natural look.  However, we do acknowledge Thermage results can sometimes be subtle and are not nearly as dramatic as those produced by surgery. 
 

References 

1  Narins, RS, et. al.  Overtreatment Effects Associated with a Radiofrequency Tissue Tightening Device: Rare, Preventable, and Correctable with Subcision and Autologous Fat Transfer. Dermatology Surgery 2006;32:115-124; January 2006. 

2  Weiss, R.A. et. al.  Monopolar Radiofrequency Facial Tightening: A Retrospective Analysis of Efficacy and Safety in Over 600 Treatments. Journal of Drugs in Dermatology – Vol. 5; Issue 8; 707-712; September 2006. 

3  Finzi, E. et. al.  Multipass Vector (Mpave) Technique with Nonablative Radiofrequency to Treat Facial and Neck Laxity.  Dermatol Surg 31 (8 Pt 1); 916-22; August 2005. 

4 Biesman, B. et. al.   Monopolar Radiofrequency Treatment of Human Eyelids: A Prospective, Multicenter, Efficacy Trial.  Lasers in Surgery and Medicine 38:890-898; December 2006.

Medspa MD: Difficulties logging in.

I've had some difficulties with the back end of this site over the last few days and haven't been able to post. (This is a tricky post by email.)

I'm hoping that Anthony and the boys will get this figured out and have me up and running again in no time. I've been busily working on the physician direct mail site and it's actually up in a beta form on the web. It's fantastic but it's only 20% completed and changing daily. If anyone's got a name suggestion I'm all ears. Leave it as a comment. If I end up using it I'll give you $500 in free printing, complete name recognition, and the knowledge that you're smarter than I am.

I'm going to be sending a beta link to everyone who's registered as a Medspa MD member so that they can take a look and provide some feedback. If you've not become a member yet, take 30 seconds and do it now. It doesn't hurt and member get all the best stuff. If I'm lying you can always use your spam filter.

Medspas: Disagree & Commit

I love that Stanford University Entrepreneurial Thought Leaders Podcast. Listen to just one and you'll quickly see why it's the most popular iTunes podcast on technology startups and entrepreneurship.

Greg Ballard, CEO of Glu Mobile, was one I've listened to more than once in the last month. Greg touched on a number of topics of interest and there was this gem on 'disagree and commit'.

Disagree & Commit

Medical clinics and service businesses are a stressful place for interpersonal relationships. The stree and  long hours are hopefully made up for by your ability to have input and make a difference. Arguments and disagreements are just part of the deal. Hopefully there is a process where a decision is finally made and everyone gets on board. (It's been referred to as totalitarianism with input.)

There is an important element in any management situation, the ability to disagree but commit. 

The failure to be able to disagree and commit is possibly the most corrosive and common situation that any business faces internally. Someone who can not commit to a course he doesn't agree with becomes a leper, infecting your business and management team. Greg describes what he sees as the highest quality as anyone in business can have as the ability to 'disagree but commit'.

I've been in any number of situations where I've seen this failure to disagree and commit in action. Advertising agency's are rife with creatives who love to gripe about account reps and clients. Doctors staffs discuss stupid patients, but are just as likely to criticize the physician they're working with or for. It's a lot easier to give lip service to agreement or get overruled and stand your ground. Hey, when it doesn't work out you can give them the old 'I know that wasn't going to work'.

If you can build a team in which disagreements can be frank, even harsh, but where once a decision is made the team can get behind it and implement without reservation, then you actually have a team.

If you can't you have a typical doctors office. 

Titan vs. Fraxel vs. Co2 Laser Ablation vs. Erbium

Some excellent thoughts on Co2 laser ablation from the Thermage vs. Fraxel discussion thread on Sciton Profractional: How's the result compare to Fraxel / Palomar Fractal / Palomar fractional IR:

".. Let's not forget what the Coherent Ultrapulse (which is not to be confused with the encore from Lum) has taught us since its popular release in 1991. Beautiful machine with state of the art engineering, but a very hot wavelength with way too much heat for rapid healing and widespread acceptance in today's modern aesthetic marketplace.

NO one can argue with the fact that after much fanfare CO2 full depth resurfacing has come and gone as a tool strictly for the most seasoned of laser professionals. The initial buzz about immediate visible contraction was lost in a sea of complications associated with using a wavelength that introduces way TOO much heat into treated tissue. To this day the majority of CO2 based systems sit in the corner of the o.r. collecting dust. Why is this? What did CO2 at 100% surface coverage teach us? One hard lesson we learned involved permanent pigmentary loss due to massive heat deposition at the DE junction. Another HEAT related involved extensive healing periods with erathema up to 6 months post treatment. Heat is intrinsic to CO2... In fact, if you treat 100 microns of tissue with CO2, you get roughly 60 microns of ablation and 40 microns of thermal damage. For reference, if you treat 100 microns of tissue with a DUAL-MODE erbium, you get 95 microns of ablation and 5 microns of thermal damage. Why does it take 3X longer to reepethlialize with CO2 vs. Erbium. Because, PULL YOUR WAVELENGTH CHART OUT CO2ers, Erbium is 15X more effective at ablating water than CO2. Why the red face for so long after CO2. Quite simple, the body is doing everything in its power to remove the dessicated tissue and is rushing in as many healing mechanisms as possible. Hence the pungent red and tremendous neovascularity.

Fyi... There is one erbium laser available that offers complete coagulative capabilities. The Sciton Contour, which has arguably replaced the ultrapulse as the gold standard for resuracing. one dual-mode erbium on the market and it was created by the same principles of the UltraPulse this makes it and the resultant ash of post delayed PERMANENT hypo pigmentation cases.

Anyways. What I was saying is the Contour was created by Drs. Dale Koop and Jim Hobart. Jim FOUNDED coherent in the late 60's and Dale was the chief engineer who designed the Ultrapulse while with Coherent in the 80's.

In searching for the BEST skin rejuvenation treatment with the LEAST downtime, we have gone full circle from 100% surface coverage heavy downtime resurfacing, to non-ablative no downtime treatments (cooltouch etc) to non-ablative fractional resurfacing (fraxel 750) to minimal downtime ABLATIVE fractional resurfacing. Now that we're back to focusing on which ablative fractional therapy is best, let's not forget that CO2 is CO2 is CO2 - redness galore, serious discomfort and who knows what the future holds for lightening. Remember, when CO2 was released in 1991, no one expected to see post delayed onset hypopigmentation. Regardless of if you're at 100% surface coverage or 20% fractional coverage with a 500 micron spot. The natural properties of CO2 make it troublesome regardless of it is a whole or fractional beam.

Rumor has it Profractional can be adjusted to treat anywhere from 10 microns to 1.5 mm in a single pulse, or scan. Also, the percentage treatment area can be varied from 1.5% to 60% of area treated. Food for thought when comparing one fractional device to another.

It boils down to two things: RESULTS and DOWNTIME. How can we best sacrifice one for the other? The answer should yield which fractional device you purchase. Oh, don't forget proprietary disposable costs." - Co2 is Co2 is Co2