Medspas: Laser burns and IPL horror stories.

Laser burns on CNN:

 
Laser treatments can be dangerous in the wrong hands. 

Video of nasty burns from medical spa laser hair removal treatments.

I would like to say that I've never seen a patient who looked like this but unfortunately I have. The American Laser Clinc patient who was burned had a similar look with this kind of a 'zipper' look where the treatment area didn't even get complete coverage.

It amazes me that someone could be treated like this. I mean, look at that pattern. It looks like it was performed by a ten year old in a hurry.

This picture was taken off of video that was shown on CNN. Does anyone know where this patient was treated?  I can't imagine they're still in business.

If you have suffered clinical negligence on this scale then speak to Patient Lawyers with no obligations.

5 Questions To Ask About Your Medical Spa Web Site.

Most dermatologists, plastic surgeons, aesthetic physicians, cosmetic surgeons and medical spas now have a web site. These range from - excellent, not bad, and blah, to downright horrible, unusable and sad. In some cases the site is so bad that it actually detracts from the message they are trying to convey. The days of unsophisticated web users are gone. In order to drive traffic and stand out, any site needs to obey these five rules:

#1. Personality:
Is there a clear personality? Do you feel like you know the business? Is there a feeling of intimacy? Your site should convey two things above all:

1. You are an expert: If you're a medical spa, you are working in cosmetic medical technology. That denotes what is supposed to be a familiarity with technology and the ability to use it. If you're site looks like it's been created by your nephew you're in trouble. Many, many, many, patients are going to research you online and make a decison about what you're like based on the only thing they can, your site. Go ahead and create a site that postitions you as an expert in your field.
2. You can be trusted: If you have a site that screams "call now", "order this product", and "going fast", just take a minute and think. You are in a market that is based in large part on trust. If you are seen as a "used car salesman of medicine", you're in trouble. The purpose of your site is not to make money. Suprise. The purpose of your site is to create the conditions that will allow a patient to overcome her natural reluctance to call and make a consultation. That's it.
   

#2. Usefulness:
Does your site read like a yellow page ad? In order to be useful to you (driving new patients) your site has got to be useful to them. Post information that is unique and useful to your clientiele. The day's of cut-and-paste are gone. You have chosen to be in a service industy so you're going to have to serve. Here is a big one... Link to articles and infomation that is not on your site! A site without external information links is like posting a "dead end" sign on your front page. Link to the article, treatment information or conditions on this site. That's what they're there for.

#3. Writing style:
Is it a sales pitch badly disguised as information? Is it a long-winded column on your CE instead of snappy and slightly-informal? Is it just a price list without analysis or insight? Anwser yes to any of these questions and you're losing money. If you want to gain a patient's trust, you have to earn it through effort. Think about what you want to convey and craft your site to do it.

#4. Usability & design:
Is the typeface easy to read? Is the information either darned useful or very enjoyable to read? Many web site designers get caught up in touting the latest and greatest tools that look flashy and cool. The problem is that they are notoriously difficult to use and update. If you're site is in Flash or uses some of the other greatest new gadgets, it may not be able to be indexed by the search engines and will cost you an arm and a leg every time you need to change something. Stick to basic HTML for the same reason Amazon and Ebay do. It works the best.

#5. Would you revisit?:
Is it useful or engaging enough for you to visit it again ? Or will you forget it the minute after you leave? If your site never changes you are losing a tremendous opportunity to interact with potential patients in a very cost effective medium.

Here are some examples and reviews of medical spa sites that you can learn from.
Warning: Materials and copy on web sites are subject to the same usage requirements as any other. This means that you can not copy or use anything without permission. There are now sophisitcated tools on the web that allow any site to find if their material is being used without permission and you may be liable.

• Surface Medical Spas: Err... my site. Something of a shameless plug.
  
• Juva Medispa - Skin & Laser Center: A middling site that doesn't do Juva's reputation as an outstanding medical spa justice. While the information is impressive, the site appears to be somewhat neglected.
• La Jolla SpaMD: A site that suffers from the "sales pitch" theme. The size and color of the copy and links are also difficult to read. There is a reason that dark type on white had been the standard since the printing press came around.
• Pure Rejuvenation Cosmetic Surgery & Spa Center: Ouch. Where to begin? Besides the name that was obviously thought up by the owner, this site does not instill a sense of confidence.
  
• The Mezzanine Spa in SoHo: A beautiful site that uses some bells and whistles but still fits the image that the Mezzanine is trying to convey. However, the site is still very static.
• Cultura Medical: An easy-to-navigate site that uses flash as a header which isn't all bad but also uses music, a big n0-no across the web.

You're site is the first interaction that many potential patients will have with you. Take the time to make sure that it works. Links to more information about marketing your medical spa.
Gourt Directory

Medsurge Advances: Email

I've had some nice emails this last week that I'll share:

From Medsurge Advances:

Just wanted you to know that I have been reading and occasionally posting on your site for about 6 months now and I think the site you have created was a stroke of genius for several different reasons: You have given many med spa owners a forum to share ideas on how to run a profitable business. You have given a forum to those considering getting into the business where they can seek advice, albeit much is by reps in hiding ( my own company included) You have created a great marketing tool for Surface Med Spa's...
Thanks,
Travis Mahan
Dir. Business Consulting Services
MedSurge Advances

Medspa Staff: Supporting customer decisions.

For your Medical Spa staff, Return Customer has some excelling thoughts on the decision making process and the way that support affects client happiness.

On why you need to reaffirm customer decisions:

There is always a bit of uncertainty when a customer decides to make a purchase. By immediately giving positive feedback to the customer that they made the right decision, you can remove that doubt.

I went to lunch last week at la Madeleine, a French bakery and restaurant. I wasn’t quite sure what to order since everything was new to me. I selected a sandwich and when I placed my order I was hoping that I had made a good decision.

And on ending all your medspa client encounters on a happy note:

The one thing your customers will remember is that last few moments of your interaction with them.

Our recent family vacation took us through Las Vegas’ airport to catch a connecting flight. As we landed, one of the Southwest Airlines flight attendants started singing an Elvis song to us over the intercom. She had a beautiful voice and even customized the words to us, her beloved Southwest passengers. Her song was followed by a large round of applause from those aboard the plane.

That act of song, put a smile on many passengers faces and wrapped up that flight on a positive note.

When you end with something good, people start to forget problems or issues they may have had earlier. A happy ending can completely turn things around in your favor.

Why is that? People have short term memories. If, during your interaction with a customer, something goes really bad, that is all they think about. Until something comes along to replace their seething anger, it will linger.

You can counter a bad experience by ending with an uplifting, positive conclusion. That newer, pleasant memory will then replace the negative thoughts of earlier troubles.

People love happy endings. Shouldn’t you try to create more of them for your customers?

The employee taking my order said with excitement: “that’s a great choice, it’s what I eat.”

Instantly I was pacified and confident I had made a good decision. My lunch turned out to be a good one.

Why is it so important to reassure the customer at the point of sale?

Your customers have mental distractions and concerns weighing them down and preventing them from fully enjoying their purchase. If these thoughts and fears are not neutralized, they are foreshadowing what will really happen.

At the point of sale, you can reassure, comfort, and instill confidence in the customer that their decision was the right one.

Armed with this confidence, your customers are more likely to be happy with their purchase. They’ll be less likely to have buyer’s remorse and return your product the next day.

Kansas State Board of Healing Arts outlaws Lipodissolve

Kansas State Board of Healing Arts outlaws Lipodissolve except in drug trials

By JULIUS A. KARASH - The Kansas City Star Story

 
In a first for the nation, the Kansas State Board of Healing Arts on Saturday greatly restricted the use of Lipodissolve, the controversial fat-dissolving injection.

The board said patients may not receive Lipodissolve unless it is authorized by a physician as part of an investigational drug trial.

“We have to protect the public from the potentially disastrous effects of unproven drugs,” said Mark Stafford, the board’s general counsel, who noted that Lipodissolve is not approved for treating fat by the Food and Drug Administration.

The Kansas restrictions are expected to take effect in mid-to-late September, Stafford said. The board’s unanimous action covers the most common form of Lipodissolve, consisting of phosphatidylcholine and sodium deoxycholate.

The action drew criticism from Matt Taranto, owner of Leawood-based Aesthetic Consulting Group, which manages AesthetiCare Medi-Spa & Lipo Dissolve Center in Leawood.

Taranto said in a phone interview that 10,000 to 50,000 such treatments are administered every month to patients throughout the United States.

“I have yet to hear of a serious reaction or side effect from Lipodissolve,” Taranto said. “It’s an effective way to address localized deposits of fat. The majority of people who have it are happy.”

But Stafford said the board has received at least half a dozen complaints about facilities that give the injections. He said the complaints, which are under investigation, involve problems with business practices and patients suffering side effects such as nodules, infections and nausea.

Lipodissolve is a trademark name. The injections are not designed to treat obesity, but rather to flush out fatty deposits from various parts of the body when patients can’t get rid of them through diet and exercise.

In May, the American Society for Aesthetic Plastic Surgery warned against the use of Lipodissolve and similar treatments. “We do not have definitive information on injection fat loss treatments,” Foad Nahai, president of the society, said in a May 14 statement. “The bottom line for patients is this: Don’t allow yourself to be injected with an unknown and untested substance.”

A placebo-controlled study of Lipodissolve is being sponsored by the Aesthetic Surgery Education and Research Foundation. The study, which will be conducted under FDA supervision, will follow 20 patients for 46 weeks to evaluate the efficacy of the procedure and collect data on reactions and complications.

It is not clear how many Kansas businesses will be impacted by the new restrictions and to what degree. Stafford said the board did not have firm numbers on Kansans who have received the injections or the number of Kansas facilities that administer Lipodissolve.

However, Stafford said the Kansas City area has had one of the heavier concentrations of Lipodissolve clinics, and the board has been aware of perhaps a dozen such facilities on the Kansas side of the metropolitan area recently.

Taranto estimated that Lipodissolve is dispensed by about 20 facilities in the Kansas City area on both sides of the state line.

The Kansas board in April passed a temporary regulation that required a physician to perform a physical exam, record the patient’s medical history and write a prescription before a patient was injected with Lipodissolve.

The board held a public hearing on Lipodissolve last month.

“Other states have been watching to see what we’re doing, and some are contemplating taking action,” Stafford said.

Mark Tucker, president of the Missouri State Board of Registration for the Healing Arts, has said that Missouri might consider stricter regulation of Lipodissolve if necessary.

Hat tip to Ron for sending this to me. 

Dermacare: Best Investment Opportunity for a Physician?

Dermacare Laser Center Franchises sent me this solicitation email.

 
I'm wondering what they're thinking? Is anyone else getting these emails? You'd better hurry. Dermacare still has a few territories available.

Best Investment Opportunity for a Physician: Dermacare Laser & Skin Care Clinics Become a leader in the aesthetic laser and skin care industry Has your practice become subject to managed care restrictions, paperwork and rising malpractice insurance rates? Is it meeting your expectations? You can get paid upfront and lower your liability by turning to non-invasive, cosmetic procedures - a $4.5 billion industry. Establish a non-surgical, cosmetic medical practice with the nation's leader in physician-based laser and aesthetic cosmetic skin care, Dermacare Laser and Skin Care Clinics®. They have a proven business model that will help you establish a practice that runs smoothly and generates a substantial cash flow. Dermacare is backed by an elite Medical Board comprised of their finest board certified physicians. The board members are on the front-line, ensuring that Dermacare is constantly reviewing the latest technology, safe practices and progressive procedures commensurate with Dermacare's standards of proficiency and "safety first." Dermacare clinics are not "Med-Spas;" they are individual practices, run by qualified physicians.    If you're looking to open an aesthetic practice or if you want to start from scratch, Dermacare now has the perfect opportunity available for you. The number of clinics available is limited due to Dermacare's dedication to exclusive territories, so this is a time-sensitive opportunity! Remember, Dermacare provides elite "hands-on" technical and management training, as well as a strategic marketing plan according to your demographics, so all you have to worry about is getting the territory you want.    Make Dermacare your practice partner today!   Dr. Abraham Sayegh, Dermacare N. Scottsdale "Reimbursement hassles, rising malpractice premiums, long hours and the threat of frivolous litigation have all affected my quality of life. Only Dermacare met my stringent requirements for a medically-based business opportunity." Dr. Sidney Smith, Dermacare Tri-Cities "The Dermacare system made opening up our clinic essentially into a turnkey operation.  The tested & proven marketing and the state-of-the-art equipment for all the procedures made it easy for us to open and generate a cash flow from day one."  Call 877-700-0788 to see if your territory is available Dermacare  Martin Kupper Franchise Sales 877-700-0788 franchiseinfo@dermacare.co

Dermacare | 4835 East Cactus | Suite 345 | Scottsdale | AZ | 85254

Medical Spa Marketing: Your DVD waiting room loop.

Waiting Room Loop DVD

 
If you've got a waiting room, it should have a big plasma screen TV with a professional presentation showing your services on it. Actually, you may not want it to be that big but certainly very visible.

Perhaps the easies way to inform your existing patients of what you're offering and keep them asking questions. Like anything else, there are some tricks and tips to achieve sales rather than have it look like you're showing your home movies.

Why does it work so well? 

 
It's free: You're already paying $15k a month in advertisng so having something that doesn't have a recurring cost is sweet, sweet love for the wallet.

It's a captive audience: You currently have one of the most desirable situations in all of advertising already built into your waiting room experience…a captive audience and people who are already inside your business. One of the biggest hurdles you have is just letting your patients know what it is you offer.

Education is the key – Research shows that up to 90% of your medical patients do not fully understand aesthetics or the services you are now offering. Showing a ten minute loop with explainations and before and after images presented in a professional way is killer and if done properly will lead to a host of questions and consults.

Insures more comprehensive consultations – Your DVD will provide a great deal of information that will shorten your consultation time and help patients better understand each procedure they are considering. The DVD is an effective tool for those patients who were initially hesitant and in need of more information before making a decision to move forward.

Turn medical “patients” into aesthetic “customers” – A DVD loop in your waiting room is the most convenient and effective way to “cross-sell” patients who are visiting you for medical reasons. Unlike patient brochures, DVD video is a powerful visual medium that stimulates the interest of your target market at a significantly higher rate with a lower cost than conventional advertising such as print, radio and even direct mail.

Personalize your practice with the human touch – A DVD will personalize your practice so that your potential MedSPA patients can actually view brief live demonstrations of your several aesthetic services. The video will help motivate your patients to ask questions, allowing you to answer their questions, express your desire and concern in providing the utmost care for your patients, and sharing your philosophy about their health and happiness. These typically are not things that can be done during a normal check-up or procedure, due to everyday time constraints.

Can an RN open a medical spa?

Here's a question I received asking if RN's can open medical spas in California.:

"I would like to initially thank you for this informative website you have created; it has helped answer many of my questions.  However, there is one point that remains a little confusing to me, and I was hoping you might be able to clarify it.  I recently went to a famous med spa in Sherman Oaks, California and asked the receptionist who it was that was administering the botox, fillers, laser, etc.  She stated that "excellent RN's"  In addition, they stated that there is an MD within the spa.  

After reading your website, it is evident that an MD supervisor is necessary within a med spa.  

My question to you is can an RN open a med spa business under the supervision of an MD in the state of California?  If so, where would you recommend we begin with the process.  It seems like your site does not approve of consultants of franchises, so what would you recommend for beginners?  Thank you for your time.
Sincerely, C.S."

Here's the short answer: No. 

A medical spa is a medical practice and operates under the same rules. So, RN's are prohibited from practicing medicine by themselves. Your question seems to ask if you as an RN could 'own' the medspa and employ a physician to 'oversee' you. Again the answer is no. Read the medspa legal forums on this site and the medspa legal category.

RN's are often used by physicians as mid-level providers and my guess is that was what was going on at the clinic you went to. But the rules and scope of practice are exactly the same as any other clinic. 

You may certainly be involved and there are ways that 'corporate entities' can align, but you should contact both the state, and a lawyer to make sure you're not violating any state regulations or licensing.

If anyone has other input you're welcome to add it. 

Laser Hair Removal for the very hairy.

In real need of some laser hair removal.

Sid Schwab's blog has a post on young man who'd undergone surgery for a pilonidal cyst and has some comments on big hairy men, but it was this image that jaw-dropped me. High school must have been hell for this guy.

I'm guessing that if you're offering a guarantee and this guy walks in, you might as well just close your doors. You should give your poor tech a bonus at the least.

To my knowledge, we've never had a patient who had this amount of body hair but then again, I'm not in the treatment rooms.

I'm wondering if anyone has any experience with the uber-hairy?

8 ways to drive your advertisers and designers crazy.

If you're just starting up your first cosmetic medical practice, you may not know why the graphic designers and advertisers of the world will shortly be clutching you by the short hairs and forcing you to cough.

Well my bespectacled brothers and sisters in white, ward yourself against the beret wearing crowd who constantly rail about 'top of mind awareness', tempt us with subliminal advertising, force us to spend money on the worst shit imaginable, and eventually blame us for not coming up with a good offer. And of course, most of them are communists.

So, in order to do my part to save your medical practice from the charts and smiles crowd, I arm you with this list of things you can do when working with a graphic designer to assure that their experience is much worse than yours.

1. Start with lame embedded graphics
When sending the art department any document, make sure it's made with a program from Microsoft Office. PC version if possible. If you have to send pictures to be used in an ad, you'll have more success in driving them mad if, instead of just sending a jpeg or a raw camera file, you embed the pictures inside a Microsoft Office document like Word or even Excel. Make sure to lower the resolution to 72 dpi so that they'll have to contact you again for a higher quality version. When you send them the "higher" version, make sure the size is at least 50% smaller. And if you're using email to send the pictures, forget the attachment once in a while.

2. Multiple and colored fonts are good.
Now we've got them right where we want them. Ask for at least four different fonts in every ad. Multiple colors are best since they really grab attention and sell, sell, sell. If the designer balks, start asking where he went to school and raise your eyebrow as though you can't believe he actually found a job. Now we're cooking.

3. White space is the fruit of the devil.
Now the first time you have anything designed it's just going to have too much empty space. They'll try to leave white space everywhere. Huge margins, spacing the letters and all kinds of hoy-ploy stuff. They'll also throw that 'clean and professional' jargon at you. Then they'll tell you that they're doing this to make it easier to read. Don't you believe a word of it. They're just trying to get off easy and leave everything half done. Stick to your guns. Ink is money and don't let them get away with more than 4% white space anywhere in the add. The type should actually be smashed into every corner.  Remember, graphic designers hate you and want your money. They're also responsible for global warming and the mercury in shellfish.

So make sure you have no margins at all and tiny, tiny text. (Bonus points for multiple colors in the body copy.) They will try to argue and may even cry. Don't worry, they're not really human so you shouldn't feel bad. Remember who's footing the bill.

4. Logos say 'look at me'.
Now of course you're going to need a logo. It's who you are. Make sure you design this yourself and flatly refuse to pay the $4-7k for a real designer, or even the $300 for an online chop-shop. Think about this for at least ten minutes and then dive in. You don't want to make something that's detailed and easy to understand. As always, multiple fonts and rainbow colors are best. Try to work in a scalpel or needle to show you're medical. Above all, be sure to include 'advanced' or 'laser' in the name of your medspa to show the world that you have advanced lasers. (People are stupid and need this.)

Without exception, when you see your logo in print, tell the graphic designer to make it bigger. If the logo doesn't not overlap the edges, you're getting screwed and no one will call and you're spouse will blame you for ruining their life. A good rule of thumb would be to have a five inch logo on a six inch ad. Actually, five and a half inches.

5. Use lots and lots of 'exciting action words'.
When describing what you want in your ad, make sure to use terms that don't really mean anything. Terms like "snazzy it up a bit" or "can't you make it pop more?". "I want this ad to really sell," or "I want an ad that really says who we are." are other options. Don't stop hammering the 'pop' and 'sell' aspects. Don't feel bad about it since the started it when they said they were interested in helping grow your business.

6. Colors make everyone happy.
The best way for you to pick colors (because you don't want to let the graphic designer choose) is to ask your staff what they're favorite colors are and what makes them want to buy. Have your staff write down their favorite colors and make a list to give to the designer to use. This is really a good one. The graphic designer will suggest to stay with 2-3 main colors at the most, but no. Insist that he use at least one color from every staff member because they really know the clientele. If you can, do this whole list thing in front to the designer and smile while you're doing it.

7. Deadlines aren't really meant for you.
When approving a design, take your time. There is no rush. What? Are they going to press without you? Take two days. Take six. You're the only account that matters and that dentist down the street is probably doing it too. If the layout guys want to really know what it's like to go without sleep they would have done residency. Try to incorporate some last minute changes by email.

8. Drive a steak through his heart.
After you've rained down this list on your advertiser or designer, he'll start to get a bit insecure and start second guessing himself. Once he realises that he just can't satisfy your needs, the graphic designer will most likely abandon all hopes of winning an argument and will just do whatever you tell him to do, without question. You want that in purple? Purple it is. Six different fonts? Sure! This is exactly what we're after. The feeling of breaking your designers hopes and dreams over your knee and casting them into the abyss. This is why you became a doctor in the first place.

You would think that at this point you have won, but don't forget the end goal: he has to quit this business entirely. So be ready for the final blow: When making final decisions on colors, shapes, fonts, etc, tell him that you are disappointed by his lack of initiative. Tell him that after all, he is the designer and that he should be the one to put his expertise and talent at work and that you've had to do everything. That you were expecting someone who actually offered insight and useful advice and didn't just sit back while you did all the work. Tell him you've had enough with his lack of creativity and that you would rather do your own layouts from now on instead of paying for his services. This even works with those poor $6 an hour guys they have at the yellowpages.

 There you go. Sweet justice for once. Next we'll work on that day spa that has the temerity to use the word medical.

Fear of looking stupid can destroy your consultation.

As a physician in cosmetic medicine, the consultation room is where the money is made, or lost. Getting patients means developing a level of trust. However, what holds many physicians back is fear.

 
In helping physicians develop a consultation that builds trust in a patient, it's clear that fear plays a pivotal role in the success or failure of your consultation and your practice. It's simply the fear of rejection.

Because of this, many physicians try to put the entire responsibility for every decision on the patient, just what the patient doesn't want.

It becomes obvious that some Physicians are afraid that putting forward options and real recommendations will place them in a position where the patient may recriminate them sometime in the future or reject them.

Or, some doctors use an 'aggressive' consultation and are defensive about any question the patient asks. (These are the doctors that 'talk down' to their patients.)

Then there are physicians who can perform a nearly perfect consultation that not only manages patient expectations, but creates a deep sense of trust and deep loyalty in almost every patient.

“Why?” is what I always ask.

There’s an obvious answer to that question: the physician exceeded the patients expectations, the patient liked not only what she heard, but what her 'radar' told her, she signed on and the physician notched up another paying client.

The important thing is that the physician didn’t give in to their fear and instead just did what was needed, overcoming fear of looking foolish or having the story rejected. And often that’s just what needs to be done.

First impressions are important, but that can also result in spending too much time trying to perfect that first contact. Remember the words of surrealist Salvador Dali: “Do not fear perfection for you will never achieve it.”

Fear of Looking Foolish or Being Rejected

This is not uncommon and is all personal ego but I'm often surprised to see it from physicians with twenty or more years of experience.

Common sense is really what’s needed to avoid looking like the fool. Make sure that you're aware of what the patient's been told and what their understanding is before you go in the consultation room. Make sure that your staff is aware that if there's anything out of the ordinary (it's a problem patient, they're a friend of so-and-so, they were treated at another clinic, whatever) they're to make sure you know this before the consult. The physician should be just as cognizant and actively question the front desk as to the situation before a consult

Problems arise when the physician or a staff member states something in conflict with what the patient expectations are or what they already understand. I've seen many physicians simply dismiss something that another staff member has told a patient to avoid the awkward embarrassment of seeming uninformed or wrong. The patient just ends up confused or thinking that the clinic as a whole is unorganized and that either, some other staff member doesn't know what's going on, or the physician is an ass.

One physician I dealt with entered every consultation with the phrase "Have we met before?" in order to put the onus of introduction on the patient. While it protected the physician from having to initiate conversation or admit he didn't remember the patient, the patients (many of whom were regulars) felt unappreciated. The staff was again left to pick up the pieces.

 Patients, for the most part, are quite willing to take on the responsibility of their own decisions. The closest analogy I can think of is a singles bar. Everyone's there to get picked up. Just don't let your fears let you go home alone.

Palomar, Cutera, Cynosure & Alma: Winners & Losers

 About Palomar's current market situation:

Revenues were down 11% for the quarter year over year. The company points out that the second quarter last year contained a huge royalty payment from Cutera for a patent license agreement. Therefore, it would like investors to subtract the payment before comparing the two quarters.

Investors weren't buying it. The stock has dropped 18% since its pre-earnings release close on Wednesday last week. The problem is that royalty payments are becoming a substantial part of Palomar's business. Just last April it added Alma Lasers to the list of companies that pay it royalty payments -- the rest of the list includes Cynosure and Laserscope, a subsidiary of IRIDEX.

If you do discount the large royalty payment, the second quarter looks pretty good for Palomar. Product revenues were up 31% year over year. Its new StarLux 500 seems to be performing well with many existing customers trading up from the StarLux300. Product revenues were also driven by increased growth outside the U.S. Sales shifted from 14% foreign sales in the second quarter last year to 29% in the most recent quarter.

There is something to the company's argument that sales growth is the more important measurement. I'd rather see a company growing sales substantially than growing revenues through licensing its technology. The patents on that technology will eventually run out and then what's the company going to do?

Between the sales growth and all the royalty payments, Palomar has nearly doubled its cash and securities from a year ago and now has $121 million in the bank. The company should probably use some of that money to pick up new technologies that might complement its current lasers. It's also developing mass-market consumer products in combination with Johnson and Johnson and Gillette, a division of Procter and Gamble, so some of the money could be used for increasing research and development of home-based products.

Via the Motley Fool

According to CIBC World Markets, the cosmetic laser market is valued at about $1 billion worldwide, and sales grew 15% in 2006 over the previous year. While hair removal remains the top use of cosmetic lasers, with growing numbers of non-core markets acquiring them -- hospitals, family practitioners, OB/GYNs, and even spas and beauty salons -- additional uses will continue to climb in importance.

Investing in the future
Competition is particularly cutthroat and research and development continues to play a central role in which company remains dominant. Based on revenues, Candela (Nasdaq: CLZR), which says it created the aesthetic laser market, is top dog with $154.5 million in sales at the end of 2006, followed closely by Palomar Medical Technologies (Nasdaq: PMTI). On a market valuation basis, however, Candela is actually at the bottom of the heap, with its shares declining in value from numerous earnings misses.

The power of ideas
A company's intellectual property remains its best defense against losing superiority. Once it turned profitable, Palomar had the wherewithal to defend its patents, and it began notifying the industry of violations. It demanded -- and ultimately received -- licensing agreements and royalties from many rivals, including Cutera, Lumenis, and most recently privately-held Alma Lasers.

It's also lined up a licensing agreement with Procter & Gamble's Gillette for the manufacture of a home-use device -- as has Syneron -- and another with Johnson & Johnson, though both are still years away from being mass marketed.

Unlike its peers, Candela has chosen not to pay up, instead countersuin on charging that Palomar has infringed on Candela's patent portfolio. In a bit of jury-shopping, it's filed lawsuits in both Massachusetts (where both it and Palomar are based) and in the eastern district of Texas, which has a reputation of siding with patentholders.

Dr. Kenneth Beer: Physician, know thy place.

Dr. Kenneth Beer is not happy. He posted the following comment on various discussion threads around this site.

Anyone who is not a dermatologist, ENT, oculoplastic has no business doing any aesthetic procedures. All PCPs, PA, RN whatever should be malpracticed out. Read the article in this last months issue, July 2007; Skin and Aging , www.skinandaging.com page 28: The Impact of Core Specialist. PCP's are NOT invited to the Cosmetic Boot Camp and this is the sole reason for blogs like these.

Kenneth Beer MD

PALM BEACH ESTHETIC CENTER

1500 North Dixie Highway, Suite #305

West Palm Beach, FL 33401

Tel: (561) 600-4848

Fax: 1.561.655.9233

Email: info@palmbeachcosmetic.com

The article to which he refers (and he authored) is here: The Importance of Core Specialists

Here are some more of Dr. Beers thoughts as expressed in this article. 

Many who advertise themselves as aesthetic surgeons, cosmetic surgeons or even dermatologists, are in actuality instead boarded in pathology, emergency medicine, internal medicine or family practice. And while they may be competent in their own areas of specialization, it stands to reason that physicians who would cut corners to get into the practice of aesthetic medicine might be more likely to cut corners in performing aesthetic procedures than those of us who have invested years in training specifically for this specialty.

Unethical Practice

As for the financial aspect of this issue, I do care that others in my community are willing to inject for half of my own fee for such procedures. Moreover, I believe that legitimate core specialists are less likely (as a group) to dilute product or substitute counterfeit than those who have cut corners. One prominent case in point: the counterfeit Botox scare in Florida. When the dust settled, it turned out that the product injected was not Botox and that the injections were not made by a medical doctor who was board certified in a “core” specialty.

In another instance that I documented, a local “aesthetic” physician who was injecting hyaluronic acids at a discount was telling people they were getting Restylane but was in fact injecting the less expensive Hylaform and Captique. This practitioner was trained in family practice and pathology, but had no core-specialty training.

...My point is that I believe those who make a habit of skirting the rules are more likely to do so in other aspects of their lives — especially their practices.

Patient Safety Considerations

What happens to patients who receive cosmetic treatments from self-proclaimed “aesthetic physician”?

They frequently have acceptable results when the treatments are straightforward and involve easily treated areas where knowledge of the anatomy is not needed and a cookbook approach is adequate. But sometimes they get burned — even literally when they are treated with lasers or chemicals by someone with no formal training.

Potential Crisis of Patient Confidence

There is now a segment of the population that has been harmed by cosmetic procedures performed by non-core physicians to the extent that they may well have sworn off Botox, fillers, and lasers entirely. For the corporations that have sown these fields by deputizing non-core physicians like my disgruntled colleague to use their products and train others to use their products, the harvest will be bitter.

As for the core specialists, we can only hope that by highlighting these differences to patients and the media, we can help to restore the integrity of our specialties. Perhaps as we begin to work together we can protect our specialties and our patients.  

My guess is that in his gusto Dr. Beer didn't read that 'plastic surgeons and dermatologists' are also members of this site or perhaps brushing shoulders with the great unwashed masses of other physicians who are busy cutting corners just got the better of him. I'm guessing that he's also missed my opinion on the medical spa franchise model and like systems. Certainly his demand that PA's and RN's shouldn't be performing procedures would put any number of boarded docs right in the can.

It's just a guess here but I'm guessing that this is the type of language that was so effective in changing the laws in FL.

But of course, Dr. Beer isn't adverse to spreading his wings into other endeavors. He has a web portal selling over the counter skin care and even has a software package that he's about to revolutionize medicine with. From a press release:

Dr. Ken Beer's dream may look something like a cross between a Nintendo Game Boy and an Etch A Sketch, but he prefers to refer to it as "the future of medicine." Beer, an entrepreneurial dermatologist, makes software for doctors to run on tablet computers.

... Beer is seeking investors and partners to help him finish and market his first program, called Dermsoftware, which is designed for dermatologists; after that, he will expand in-to other medical specialties. At $24,000 to $32,000 per system (which covers the software license, upgrades, and a Hewlett-Packard server), Beer knows that he is asking a dear price. But he is convinced that medical practices will gladly pay it.  

I too am the object of Dr. Beers wrath since when he signed up as a member of this site he tersely requested that I 'shut this site down immediately'.  Heavens I'm becoming unpopular. Perhaps I'm the only one on the planet who could create an alliance between Beers and Mudd.

Dr. Beers is not only letting his obviously substantial ego run amok, he is chasing a red herring in this case.

"Anyone who is not a dermatologist, ENT, oculoplastic has no business doing any aesthetic procedures. All PCPs, PA, RN whatever should be malpracticed out."

Perhaps Dr. Beers misunderstood what the definition of dermatology actually is while he was career planning. Here's the first definition I found.

Dermatology: The branch of medicine concerned with the diagnosis, treatment, and prevention of diseases of the skin, hair, nails, oral cavity and genitals.

Dermatology wasn't designed to be 'cosmetic' medicine. It's the study of diseases of the skin. The 'cosmetic' aspects of medicine were inherited by dermatology and plastic surgery as they were the closest medical specialities.

So now you have dermatologists who identify themselves as 'Cosmetic Dermatologists'  because there's an understanding that the cosmetic aspects of medicine don't fit under the disease aspects that really is dermatology.

Which brings us to the changes taking place in in medicine. 

The physician of the future will be managing technology, not utilizing an individual skill set. Physicians are a hugely inefficient method of delivering treatments. They're expensive to train, they're slow,  and they're expensive. Dr. Beer really is fighting city hall on this one.

What's better... technology.

Medicine is moving to technology solutions. That's what the market demands. That's what is happening and nothing that anyone says or does will change it. It's happening faster in retail medicine because it's not encumbered by the inertia of the third party payer system but it will happen in all of medicine.

A useful analogy would be the family farm. Everyone likes the romantic notion of the family farm. In fact, legislation is passed and moneys provided to keep family farms in existence. But if you think that the family farm will exist in a hundred years outside of a living museum you're mistaken. The family farm is inefficient and markets and progress demand efficiency. So the family farm will change to more efficient methodologies. Any effort to save family farms just forestalls the inevitable. It's the way of the world and nothing that you, I, my farmer friends, or Dr. Beers does will change the way that markets work.

And as new technologies are developed faster, it negates the 'training' that was needed to ensure the effective delivery of the treatments. I'll bet that there's not a dermatologist in the country who performs every bikini line hair removal treatment in their cosmetic practice.  Where are these hidden hoards of board certified derms and ENT's that are ready to fill the cosmetic demand?

Dr. Beers position would not ring as hollow if he was focused on who could safely deliver services rather than the protection of a club to which he belongs. Certainly his position seems to be that any physician offering Botox who is not a boarded dermatologist is a quack.

I'd suggest that there's an argument that there is a strong ethical conflict for all dermatologists performing cosmetic treatments.

Skin cancer will soon become the most common cancer in the US. In most cases there's a two month wait to get in to see a dermatologist to take a look at a mole. It could easily be argued that any dermatologist performing cosmetic procedures is selling out needed patient care to cash in and make a buck.

I don't subscribe to this theory myself of course. It's just a thought. 

Florida Chiropractor offering IPL.

I was having a discussion with one of my consulting clients today and he dropped this nugget on me.

There's a chiropractor in Florida who is telling other chiropractors that IPL is within their scope of practice. In fact, he's training other chiropractors and selling them equipment. Here's his site: BioDerm Medical Incorporated .

You'll notice on the about page that he's got an MD and is, "licensed to practice Chiropractic Medicine in FL and KY.  He is licensed to practice Oriental Medicine and Acupuncture in WV, and is registered to practice Medicine in Montserrat."

That Monserrat medical 'registration' seems like it may come in handy.

According to this chiropractor:

• IPL is within the scope of practice of DC's since they can use light based therapy's.
•  He was hauled in before the Chiropractic Board of Florida and successfully defended himself by showing that: Although the state of FL regulates IPL as class 4... it's really class 2 and he proved it. The state dropped the entire investigation.
  
• Any other chiropractor can do the same thing.

Since the recent changes in Florida prohibiting non plastic surgeons and dermatologists from overseeing second clinics. This seems odd to me.

Physician Ethics & Cosmetic Medicine: Are you a money-hungry whore?

The post on LS, a dermatologist that's pissed at OBGYN's and FP docs in cosmetic medicine has 51 comments as I write this.

 
Certainly there will probably be more.

I've posted three comment from that thread here. Disenchanted is not generally happy with docs whose  

Disenchanted thinks that physicians who are not plastic surgeons or dermatologists are 'money-hungry whores'. (emphasis mine)

As a second year resident having survived internship and still possessing a genuine interest in patients suffering from disease, this whole thread saddens me. No wonder the prestige of the physician has fallen, what a bunch of money-hungry whores. You can have all the lasers and cosmetics and make your money...better yet just trade in your MD for a cosmetology degree and think of all the lives you can make better and impact you will have on the world. Non-plastics/derms who do cosmetics have no professional integrity. All of the above posts are just sad justifications for selling out. I want an FP who will provide appropriate preventive care to my family (if you don't like how GME are reimbursed, spend the time/resources you put into cosmetics courses into a lobby for change). I guess since there's finally some awareness that Obs are cashing in on unnecessary C-sections (hysterectomies etc), need more ways to make cash money. My 2c, flame on brothers and sisters.   

LH thinks he's somewhat naive.

Disenchanted, You probably are barking up the wrong tree. So what you are saying is it is OK for derm/plastics to do cosmetic procedures and anyone else that does is a money-hungry whore? I do not get the difference.

I think your opinion will change after you have done this for a while. I would like to speak to you in about 15 years when you have worked 70hours per week been up for 36 hours straight and delivering hundreds of babies in the middle of the night. You get about 1 week vacation per year and your family forget what you look like. All of this to continue to have to work harder to make the same income.

Also, you may want to understand that some of us actually enjoy the artistic side of cosmetic procedures. I also enjoy it because I get to spend more time with the patients.

So I have chosen to alter my career path and that makes me a whore in your eyes. I am OK with that and will not lose an ounce of sleep over it. It is much easier to change my path than the entire practice of medicine. I have fought many a battle including the political ones. It is best for you to look at the serenity prayer "God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference".   

(Prodocs also comments)

DermaDoc also has something to say.

If I may chime in here for a moment - I am guessing Disenchanted is a resident who went directly from high school to undergrad to med school to residency and has never had a real job or real responsibilities in his/her life. I have been through residency, built a practice, served the underprivileged, and spent many sleepless hours on call taking care of 'real' patients. And I still do because it is who I am. I find it more indicative of a poor attitude that someone in residency already has a grudge against people that may horn in on the money making territory as a matter of free competition rather than settle for our dwindling reimbursements, skyrocketing overhead and more and more demanding professional obligations. I've done my time and no one else is going to pay my mortgage but me. I am not abandoning my patients at al, I am simply making my life better so I can be at my best when they need me.

On the other hand, the medical field looks like crap these days, so I can understand a little bitterness on the part of a resident who has already put a bunch of years into training with a constant stream of bad news about their prospects for a decent lifestyle and working conditions.

So Disenchanted, don't take it out on us if we are in survival mode. Find what you love doing and do it regardless of the payoff. I thankfully have found that place myself. Not alot of cash but I actually enjoy what I do, and that is fine with me.  

As for myself, I'll point out that Disenchanted's suppositions rests on a number of key points that are tenuous at best:

• That no physician should be able to change their mind or practice after deciding upon a specialty.
• That, for some reason, physicians who decide on a 'cosmetic' specialty like plastic surgery or cosmetic dermatology have somehow taken the high road (This one I really don't understand.) and since they chose one of these early on that they are somehow more ethical that physicians not 'core trained'. (Why Disenchanted gives them a pass on this I have no idea.)
  
• That physicians choosing  to perform or offering cosmetic medicine are neglecting the obligation they have to their patients.

Since consulting, I've been approached by physicians from the following specialties: Plastic Surgeons, Dermatologists, Anesthesiologist, General Practitioners, Emergency Room Docs, Internist, Family Practice, Cardio-Thorasic Surgeons, General Surgeons, Psychiatrists, ENT, OBGYN, (I know I'm forgetting a lot).... and even a Pathologist. I've said no to many more than I've said yes to, and I have met a number of physicians who I felt were money-hungry and yes, even unethical. But not many. 

I also have nothing bad to say about Plastic Surgeons or Dermatologists. 

Certainly I understand how Disenchanted feels. But I'm afraid that the holes in the argument are just too big. I would have thought that Disenchanteds derision would have been more thoughtfully focused on Plastic Surgeons and Dermatologists performing cosmetic treatments. Certainly skin cancer should be the focus of Dermatologists and Plastic Surgeons should be performing cleft-palate repair. I would think that Disenchated should laud the Family Practice doc who frees up these specialist for their needed work since it's really not that hard to perform a Botox injection and the patient's right there for their flu shot anyway.

It brings to mind the following quote: "If you're not a liberal when you're twenty you have no balls. And if you're not a conservative when you're forty you have no brains." 

Why every physician should be blogging.

The  Independent Urologist has an excellent post on why you should be blogging as a doctor..

By blogging actively and transparently--in your own name--you can influence the dialogue that already exists and turn it in your own favor. Your blog should be compelling, honest, and well written, and if it meets those criteria, people will find it and link to it. The more posts, the more links, and the higher the google organic ranking. Plus, it's fun, and you'll make friends.

All of your posts should be linked to your own website, if you have one, and--this is key--you must blog in your own name and be proud of what you write.

This way, you can influence the conversation that takes place in cyberspace that is about you.

You really should blog or have your staff blog. If you don't know how, it's actually incredibly easy these days. I recommend the site that I use (Read my review of squarespace here.) It literally only takes about 3 minutes and you're ready to go. If you can use email or word, you can manage this system.

It's also good business. Linking your blog to that static site that you paid to have built might mean that someone can actually find out what you do and offer on the web. (I'm not kidding.) 80% of potential patients are using the internet to research major purchases. Blogging gives these potential patients an opportunity to find you and give you a point of contact and trust building.

Take a look at some of the physician blogs listed on the resource page. You really should be blogging.