Paula D. Young RN joins Medical Spa MDs Editorial Staff

Medical Spa MD is proud to announce the addition of Paula D. Young RN to it's editorial board.

From the Medical Spa MD press release: It's a fantastic addition to Medical Spa MDs ability to provide expert viewpoints from a diverse group of expert medical providers and business people. Paulas experience will give Medical Spa MD voice for mid-level medical providers an an invaluable resource for the growing number of medical estheticians and laser techinics who are visiting Medical Spa MD to learn.

ABOUT Paula D. Young RN

Paula is the staff nurse and co-owner of Young Medical Spa in the Lehigh Valley area of Pennsylvania along with her husband Thomas E. Young, MD. Prior to establishing Young Medical Spa, Paula previously owned a Merle Norman Cosmetics national franchise, a full-service beauty salon and spa, and a chain of tanning salons. Most recently, Paula worked for Johnson & Johnson for over 10 years and held senior management positions in the medical and sales education, and customer relationship management departments. Her associations include:

• Dermatology Nurses Association
• American Academy of Medical Esthetic Professionals
• Association of periOperative Registered Nurses
• American Nurses Association
• The Aesthetic Practice Association

Paula also holds a current license with the Cosmetology Board in the State of Pennsylvania. She has written for Medical Spa Report Magazine and authored a textbook on Advanced Aesthetic Practices.

You can read all of Paulas posts on Medical Spa MD here.

Medical Spa Estheticians: Charting (or not charting) Your Termination Notice

Many aestheticians coming from the day spa industry into the medical spa environment have to learn a whole new way of documentation as a client now transforms into a patient.

Aestheticians who are used to time and date stamping treatments with occasional side or progress notes, now are expected to chart everything they say and do during a patient’s treatment. Along with charting comes treatment consent forms, HIPPA Forms, photography consent forms, payment agreement forms, anatomical charting forms, etc.

Anyone who has contact with a patient, in immediate regards to their treatments, should be charting everything from follow-up phone calls, to letters mailed, to topicals used and the patient’s response, to laser settings and the patient’s response, patch tests, follow up appointments, and patient’s tolerances to therapies.

The once client file has now transformed into a medical record by all standards which could stand up in a court of law. Some aestheticians I have spoken with have not learned the art of charting and feel they should not be required to do so.

Why is it so important you ask? Unfortunately, there have been more horror stories hitting the media than stories of healing and hope, especially when it comes to therapies that involve lasers. These unfortunate circumstances are a catalyst of change to laser laws across the U.S. Whether the MD is on site or off, they (along with the therapist) can be held liable for any legal implications filed by a patient at the hands of a clinician or aesthetician.

Harsh as it may seem, and it has even happened to our practice, even the most skilled and brilliant aesthetician could be terminated if they refuse to properly chart a patient’s care. Our rule of thumb is... if you didn’t chart it, it didn’t happen.

I’m interested to know what your facility’s requirements are for charting, and what implications can arise if you fail to comply?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Medical Spa MD: The 6 best ways to earn and use patient testimonials, associations, and third party endorsements.

Patient testimonials, third-party reviews and endorsements, media coverage... these can all differentiate your medical spa, plastic surgery, or cosmetic dermatology practice and convince potential patients to give your clinic a shot.

While search engine marketing (SEO), pay per click (ppc) and direct mail can put your practice in front of potential patients, third party patient testimonials can provide the needed level of ‘trust building’ to initiate a first contact.

The three types of third party validation for medical spas, plastic surgeons, and cosmetic dermatologists:

Direct Patient Testimonials: You’ve seen this if you’re not already doing it. Prominent display of your patients saying nice things about you.

Trust Through Association: The reason that you’ll put your FACS, ASAPS, AAD, or ASDS logo on your site is to build patient trust. It works. Of course, theses associations are completely restricted and very protective of their turf, leading to less restrictive medical associations who want to gain credibility. The reason MAPA was formed was to add some legitimacy to a group of non-core physicians. These associations are always pay to play.

Third Party Endorsements and Validations: Botox ‘premier providers’ is an example of third party endorsement as are others that are run by medical service companies. (If Medical Spa MD links to your medical spa it’s a third party endorsement.) Interestingly, third party endorsements actually have a more favorable impact than association endorsements since the third party is often more ‘relevant’ to the initiation of a financial transaction.

When you receive these kinds of accolades or promotions from prominent third-party players, if validates what you’re doing and provides the potential patient you’re marketing to a level of instant comfort that you’ve already been checked out and are the ‘real deal’.

Subtle changes to the way you’re handling your patient testimonials and third party endorsements can produce dramatic effects, especially online, where the majority of patients are now searching for information.

Medical Spa MD: Quick strategies for piling up and using patient endorsements

Target the places your patients already are: First and most importantly is your existing medical spa or cosmetic practice but you’ll be able to reach far out into the community and gain the endorsements of other prominent businesses and individuals

Identify third-party recognition programs: These are most often paid inclusion but there are ways to get these types of third party endorsements for free, or at reduced cost.

Prepare legal and media write-ups: The media only runs two types of story; we found something good and, we found out something we thought was good, was really bad. Uncover the ways to build this kind of content that you can use on your own site, and share with you local media outlets.

Provide ready-made strong human interest and strong visuals: Patients and the media love photos. If your fractional laser resurfacing before and after pictures suck, you’re losing traffic and paying patients. Learn how to manage your photos and make them more than just snapshots.

Give patient testimonials prominent placement: If you don’t have your patients smiling photo, full name, and a stellar testimonial, you’re less effective that you could be. Learn how to get patient testimonials that are truthful, candid, and really work. Read these testimonials from Medical Spa MD Members touting the benfits of belonging to the best cosmetic medicla commuity on the web.

Look for latent patient traffic, not spikes, from these techniques: The effective use of third party endorsements and patient testimonials work and drive patient flow, but it’s not a technique that provides an instant boost. It’s begins a trend and compounds over time.

If you’re not using patient testimonials and third party endorsements to drive patient flow, start now, your medial spa, cosmetic dermatology clinic, or plastic surgery practice will benefit far into the future.

And of course Medical Spa MD uses testimonials too. Read these testimonials from Medical Spa MD Members:

Mitchell Chasin, MD: Reflections Center for Skin & Body, Livingston NJ

Medical Spa MD helps us to stay focused on the details that make the difference between a thriving practice and one that is languishing in this sagging economy.

Medical Spa MD is an important resource that I recommend to anyone who wants to understand the trends and stay connected to the ever changing aesthetic community.

Paula D. Young RN: Young Medical Spa, Allentown - Lehigh Valley, PA

To really know what's going on in the aesthetic business you MUST join Medical Spa MD! Nowhere else can you find the information crucial to your success in this ever changing arena. From the classified ads section, to the professional community forum discussion threads, to real equipment reviews by aesthetic professionals. I especially value the articles on marketing and the community forum discussions on therapy management like melasma, fillers, laser lipolysis, and skin resurfacing. Medical Spa MD keeps me on my toes as a medical spa owner, marketer, and nurse!

Susan J. DeGuide, MD: Inovamed, Rockford IL

I found Medical Spa MD several months ago and immediately added it to my “Favorites” list. I check the site several times a week to look through the new posts. I enjoy learning about new technology, expanding my knowledge of the technology I already own, and knowing that I’m giving the best available care. I would not buy a new piece of equipment now without first consulting Medical Spa MD.

Ronald Berglund, Former Medical Spa Franchisee. Sybaritic, Inc.

...we no longer feel like we are "all by ourselves" out there. There are a myriad of challenges involved with operating a successful and profitable medical spa, including marketing, sales, operations and procedures, clinical, human resources, regulatory and legal. Another huge issue for everyone is choosing the best equipment for the price. With the help of the "medical spa equipment for sale" feature I have been able to sell several pieces of used equipment. Trying to use E-Bay and other Internet-based options was a nightmare.

Jeffery E. Epstein MD: Founder Medical Aesthetic Practice Association
& Cherry Hill Laser & Skin Care Center

When we look back on the early 21st century with regards to Cosmetic Medicine, we will think of R. Rox Anderson, The Carruthers and we will think of Medical Spa MD. By providing this platform (Medical Spa MD), Jeff Barson has done more to advance Cosmetic Medicine than Anderson and the Carruthers combined. There has been a paradigm change in the cosmetic medical world and it can be directly attributed to Medical Spa MD!

Do you make a difference?

I’m very excited to be blogging for Medical Spa MD, a site I turn to to keep a pulse on what’s happening across America in the wonderful business that is aesthetic medicine! Where else on the web can you find such an open and informative forum to share, help and learn?

I found myself getting tunnel vision, only considering what’s happening in my immediately demographic marketplace and began to wonder how aesthetic practices differ in other States. We all know we share the same downfalls of the economy, but do we have similar therapies, marketing strategies, and products/services? Is there something new on the horizon that has us all excited, or could change the scope of our practice as we now know it?

Like most of you, I hear about new and innovative products and modalities coming into the arena at trade shows or from sales reps. What usually lacks is the experience the professional public has had with these “show stoppers”.

I read content on this site as a nurse, a marketer, a medical spa owner, an employer, all while keeping my mind open as patient. While the discussions between physicians are highly informative and educational, my desire is to review subject matter for ancillary personnel... the nurses, the aestheticians, the medical aestheticians, and general support staff.

Other than their education, experience and skills, we are the foundation on which physicians build their practices and trust in us to help them and the practice thrive and our therapies be safe and efficacious for our patients.

In this blog, we’ll take a look at current issues and everyday concerns such as new laws, therapies, products, office procedures and policies, and marketing strategies. As support staff members, we should feel a sense of ownership and pride in what we have chosen to do in our profession.

It will begin here... as casual thoughts and occasional epiphanies between colleagues. So, I must ask you... how are you making a difference?

Paula D. Young RN - Newest writer for Medical Spa MD

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.

Medical Spa Consultants in NYC

Spa NYC is looking to open a Medical Spa and has talked to some Medical Spa Consultants.

We are looking into opening a medical spa. We are physicians, general practititoners, and have spoken to several consultants who would provide assistance to do the business planning, financial proformas, operating procedures, assist in hiring staff, marketing, equipment recommendations, space planning, info systems recommendations, web site development, etc.

We are located in the greater NY metropolitan area. anyone use a consultant they would recommend, or is it even worthwhile to do so?

And here's my response:

Beware. The vast majority of medical spa consultants are less than worthless in my opinion. Thre are only two that I've ever recommended and they both specialize in a specific niche.

Physicians are, as a rule, intelligent, but they think that because they're intelligent that they'll be able to 'think their way through' a problem. That's not generally the rule. Physicians have a reputation for being poor at business and there's reason enough for that.

The real cost of poor medical spa consultants is that they waste your time and distract you with irrelevant things like proformas statements and excel worksheets that project your earnings. Useless. Of the dozens of clinics I've been involved in and the millions of dollars spent and made, I've yet to see one single medical spa business plan that was worth a piss in the wind.

My advice is this. Go slow. The market isn't going to be kind to those who make mistakes and you can easily spend a couple of hundred thousand dollars in a bloodbath education. Just ask the myriad of physicians who regularly frequent this site. Go slow. Go slow. Go slow. Spreadsheets are worse than useless as are business plans. I've written dozens and they're used to give a sense of security where there is none.

Choosing technology? Note this sentence from Susan DeGuide MDs testimonial on joining Medical Spa MD: "I would not buy a new piece of equipment now without first consulting Medical Spa MD".

Post a question about the technology you're investigating and you'll receive responses and possibly an offer to talk by the physicians who are using it. If you don't take advantage of this resource you're too stupid to be practicing medicine. (Getting off on a little bit of a rant there... sorry.)

If you're looking for someone to build your medical spa for you so you can just step in, work 40 hours a week, and own everything, you've already lost. Cosmetic medicine is an entirely new area for most non-core docs and there's a learning curve. Don't get ahead of it. The greatest thing about Medical Spa MD is that you're able to find and network with physicians who are not your direct competition and are willing to help. Take advantage of it.

If you have some advice for a physician group in NYC that's opening a Medical Spa, help them out here or in the forums.

Learning from Sciton

I'm not sure how long Sciton's been in the forums or if they just found the Sciton Anyone forum thread but it's nice to see that at least one of the IPL & Laser companies is willing to respond to a forum discusson.

Palomar, Cutera, Lumenis and everyone else would be welcome.

Free Marketing Report: The best & worst tactics for medical spa profitability.

The impact of the economic slowdown on elective healthcare services such as cosmetic procedures and LASIK was almost immediate. Initially the impact was regionalized to those areas with the highest decrease in home value. But as the year progressed and the economy worsened, the majority of elective healthcare practices experienced a decrease in new patients and patient conversions.

To quantify the effect of the slowing economy on cosmetic practices, CareCredit asked Hiner & Partners, Inc. to survey 10,000 CareCredit practices to identify tactics they were successfully using to increase or maintain sales and profitability. Participants were contacted via mail, email and fax to participate in the web-based survey. This report summarizes the key findings of that market research initiative to help cosmetic practices compare and analyze their current status with peers across the country and to share best practices.

Get the PDF Download:
The Economys Impact on Cosmetic Practices & Tactics to Maintain Profitability

Key Findings

• 61% of practices reported an average decline of 32% in monthly sales as compared with 2007
• Only 13% of practices reported an increase in sales
• 26% reported same level sales as 2007 The decrease is impacting both surgical and non-surgical practices
• 64% of surgical practices reported an average 31% decline in monthly sales
• 56% of non-surgical practices reported a 34% average decline.

The economy is affecting all areas of business including inquiries, consultations, commitments, completed procedures and repeat customers.

Redness after IPL & Laser Treatments: DeepFX & ActiveFX

For those who are seeing a lot of redness after DeepFX & ActiveFX treatments:

I am getting lots of redness which is lasting 6 weeks and longer.
Checkerboard where I did Deepfx. Any suggestions about how to avoid or help
it fade faster. It fades to the point where it can be covered up within 2 weeks,
but still would like to know any tricks you have come up with.

Also for men, they don't use coverup makeup! - so this is more of a problem.

Finally, any tips for better visualization of where you have treated with
DeepFx? Hard to see pulse patterns and with blood and serum oozing, hard to tell exactly where you have been. Any tips??? Are you all having the same problems?

I do Deepfx at 17.5 j with Density 3
I do ActiveFx over deepfx at density 1 energy 70 (to blend color).
I try to place pulse patterns right next to each other without leaving
spaces. I do Activefx around the eyes (not deep)

Plastic surgery secrets revealed: Vanity goes undercover.

Melanie Berliet, a Vanity Fair writer, went undercover to test her hypothesis that plastic surgeons try to sell additional procedures to patients that they don’t “need.” The 5’9”, 120-pound 27-year-old, who wears a size 34B bra, went into the consultations under the guise of wanting breast augmentation.

Some of the plastic surgeons did not come out looking very good. The three surgeons had different reactions to her physique, but all of them recommended procedures she hadn’t originally asked for.

The one plastic surgeon who did fair pretty well had this exchange with the author:

He goes through the standard health questions, then asks, “How can I help you today?”

“I was just hoping to get a professional opinion about my options in terms of plastic surgery.”

The doctor squints and replies, rather emphatically, “The way it works is: you tell me if something specifically bothers you, and I’ll tell you if I can address it. But I’m not here to sell you services or goods, because there may be something that you don’t see that I see.”

“And you won’t share?,” I ask, somewhat startled.

Dr. Racanelli explains that he has an ethical problem with pointing things out, because he’s heard of cases in which patients felt they were talked into a procedure. He continues, “If there’s a specific area of concern, then you and I can discuss it at length ... I’m not here to, like, pitch you.”

“Is it a legal problem?,” I ask.

“No. Not a legal problem. It’s just the way I like to do things.”

In that case, I tell him, I’d like to talk about my nose and boobs.

Satisfied, the doctor proceeds. Most of what he says is familiar. He says I’m tall enough to carry a full C-cup, and observes that my nose has a “dorsal hump” and a “bulbous tip.”

“Is there a way to image what it might look like?”

“There’s a way to image, and it’s a very successful marketing tool,” he replies. “I do not do it, and the reason is: the only person who knows what your nose is going to look like after surgery is God.” Despite my general discomfort with superfluous references to a higher power, I feel the urge to jump out of my seat and give Dr. Racanelli a standing ovation.

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Sciton BBL treatment parameters for pigment & redness.

Not to be left out of the IPL section, the Sciton BBL IPL treatment parameters for pigment and redness.

I have a Q regared the 515 filter and lentigines. With the 10ms pulse widths I have seen moderate rxns at 11-12J with 25 cooling in type 2s ( moderate erythema with accentuation and darkening of lentigines). When I moved to 20ms 9-10J with 18 cooling in type 3 and 4s I saw no immediate response (eythema or darkening). I spoke with a patient today who stated minimal darkening 24hr out. These are the recommended settings but they do not appear to have the punch. Has anyone tried lowering pulse widths to 15ms or even 10ms with cooling let's say 15 to protect surrounding skin?? I have lot's of type 3-4s with lentigines. Your suggestions appreciated...

Live Physician Chat: Sciton BBL (Cosmetic IPLs & Lasers)
Tuesday February 24, 2009 9 - 10 PM EST

Fraxel 1500: Rashes, reactions and treatment protocols.

More from the Fraxel 1500 crew here at Medical Spa MD Forums; Fraxel 1500 treatment protocols, rashes, and reactions.

In response to a complaint of redness after a treatment with the Fraxel 1500:

Maybe this can help...

I have seen rashes like this occuring after thedoctor (chiropractor) at my office performs a fraxel treatment. He is known to not wipe the numbing cream off thoroughly and then puts the gliding gel on directly after. After performing the treatment he does not thoroughly clean the skin and immediately puts aloe on the skin. Clients usually come in days later complaining of a rash and itchiness, especially on the cheeks and chin. Im guessing the rash is from a combination of the heat and multiple substances still being on the skin. It is very important to make sure that the skin is very clean before, during and after the treatment. The topical we use is a 7/7 lidocaine/tetracaine combo and most clients that I've treated come out pretty good without any complications after aside from the swelling.

After the treatment I let the client sit with cold aloe vera along with the simmer chiller blasting cold air onthe face for about 15 mins. Then I have them rinse the skin and I immediately apply the Neocutis BioRestorative Gel that is very light in texture and great for post op care. The Neocutis line is great for burns, scars, rashes, irritations and is best for after fraxel treatments for the first week. It helps the skin get back to a normal state. i usually sell these products along with the Fraxel package so that the client can use the products at home and continue caring for the skin properly. Using anything thick like a vaseline base, bacitracin, heavy creams immediately after the treatment and during the first week post op will irritate and clog the skin and cause more complications.

Fraxel 1500: Pain control when performing fractional treatments.

There are some new comment threads of interest in the Physician to Physicain Forums including this one on the Fraxel 1500 and pain control when performing treatments.

What is the strongest numbing cream that you can order from a compounding pharmacy?

I currently get a combination of lidocaine/prilocaine that the pharmacy will not tell me how and what concentration it is. It is better than Emla, but is there anything else out there? Currently we are getting people through the CO2 first pass with my cream, a 10 mg of Vicodin and 2 mg of Ativan, all PO, but when it comes to the dynamic phase where I blend, they start squirming. I am at the point, I may start to do conscious sedation with Fentyl and Versed. If anyone is using the Lutronic CO2, my settings are 100-160 mJ and 100-150 spots/cm2(density is automatically calculated for you)...

Looking for used Thermage tips?

I had thought that the reactivated or used Thermage tips had been exterminated by Theremage, but I guess not. I've received three emails this week asking for contact information for the gray market providers.

Syneron Ematrix: Fractional resurfacing webinars

Syneron is launching Ematrix fractional resurfacing and promoting it with webinars.

Join Dr. George Hruza in a 1-hour webinar as he presents his early and ongoing findings as one of the initial investigators for Matrix RF - the worlds' first RF-only fractional skin resurfacing technology. Learn why eMatrix with Matrix RF is revolutionizing fractional skin resurfacing.

I've never had any interaction with Syneron so I don't really have an opinion. I'd like to hear from anyone pro or con as a user. Anyone ever attended one of these webinars?