American Board Of Laser Surgery

I get a lot of questions from laser physicians about the American Board of Laser Surgery. I thought I would leave a short post about the benefits of becoming a diplomat of the ABLS. It is the only recognized specialty board specifically for laser surgery. We have members from many countries because most other countries do not have a laser board. It is like any other board certification with a written and oral exam.  Through the process, the practitioner will gain extensive knowledge about laser procedures, safety, theory, physics, and other information. Feel free to ask me any questions about it! 

American Cosmetic Surgery Numbers By Region

American cosmetic surgical procedures in the U.S. by region.

North East: 302,000 cosmetic surgeries

• 29% Nose Reshaping
• 20% Facelift
• 18% Eyelid Surgeries
• 17% Liposuction
• 15% Breast Augmentation

South East: 289,000 cosmetic surgeries

• 23% Liposuction
• 23% Facelift
• 22% Eyelid Surgeries
• 16% Breast Augmentation

South: 258,000 cosmetic surgeries

• 17% Breast Augmentation
• 17% Nose Reshaping
• 16% Tummy Tuck
• 15% Liposuction

Midwest: 242,000 cosmetic surgeries

• 31% Dermabrasion
• 17% Breast Augmentation
• 14% Nose Reshaping
• 13% Eyelid Surgeries
• 13% Liposuction

West: 485,000 cosmetic surgeries

• 36% Breast Augmentation
• 34% Eyelid Surgery
• 32% Liposuction
• 31% Facelift
• 27% Nose Reshaping

* Percentages may aggregate to more than 100% do to the same patient having multiple types of treatments.

Laser/IPL Procedures For Patients With Skin Cancer History

There was a recent posted question on the American Board of Laser Surgery's website about treating a patient who has had basal cell carcinoma (BCC) in the past with a treatment like IPL.

This is obviously a controversial topic for sure!

My protocol (remembering that I am a surgeon) is that anyone with a history of skin cancer must have a full body skin cancer screening in the last six months by their dermatologist prior to me treating them. I must have a letter from that dermatologist stating that there is no active cancer anywhere on the skin and no suspicious lesions that need to be followed. Obviously, if there was a h/o skin cancer on an area I am NOT treating with IPL or laser, I just want a full body check and then we're good. If there is a previous lesion IN the area I am treating, then after dermatology clearance, I have a strong talk with the patient discussing the fact that treatmetns that potentially depigment lesions can mask the warning signs of a potential or growing cancer. They sign separately in consent their understanding and acceptance of risk and wish to proceed with the cosmetic treatment.

This particular question was regarding a simple IPL treatment for a cosmetic concern in a patient that had had h/o BCC in another area. If cleared, you would be fine to treat the cosmetic condition. I did not want anyone reading this to think that I was indicating that the IPL was meant to actually treat the BCC. I do think that it can be preventative of precancers buy removing damaged pigment cells and pigment, but that is obviously an impossible study. Hope that helps!

Medical Spa Marketing: The Rise Of The "Social Shoppers"

How active are you in attracting new patients through your social networks?

The growth in the online ad market is undeniable. Double digit gains of over 20% for 2011 were seen and 2012 will likely follow suit. This mega trend in marketing has changed our marketing strategies in our practice as well as how consumers are choosing their cosmetic provider. I have seen many mature practices where 60% or more of their patients come from internet sources. I have several colleagues who currently grow their practice through web related activities or word of mouth referrals exclusively.

Patients seeking cosmetic services have evolved their research methodology considerably from simple web site searches a few years ago to a search that is much more comprehensive. Patients want much more information about their providers outside of a curriculum vitae and a smiling photo. Three years ago, outstanding patient result photos were enough (btw, most practitioners fail to remove outdated photos or marginal results). In the age of social media, I refer to a certain group of internet savvy patients as “Social Shoppers”. This means that essentially if they don't have a best friend that has personally experienced your practice, then they need to perform enough research to feel like they know your practice personally. An outstanding website with great results is a large portion of the picture, but patients want unbiased affirmation that you have the expertise and track record of results for their particular procedure of interest. In our practice, we have always emphasized specialization and core expertise. By only performing certain types of procedures and literally refusing potential patients, we have grown our practice in core areas and augmented our expertise. There are reams of data to support better outcomes when people focus on certain tasks repetitively. Variety is the spice of life but repetition is the sugar!

A task list to satisfy “social shoppers” 

1. Encourage your patients to review you online. You have great results and there should be evidence of this online for your patients to see.
2. Actively blog about topics relevant to your core expertise and interest area. Focus on being an expert in your community and region.
3. Become involved in social media cosmetic services forums Realself.com.
4. Find your voice. As your writing volume increases, you will find a voice that demonstrates your expertise, attention to detail, and empathy. 

Peeling Melasma

Treating melasma is one of the most challenging indications in aesthetic dermatology.

In my hands and over the years, chemical peels in combination with bleaching agents still work the best. Most recently, very interesting and promising new bleaching cosmeceuticals are coming up, matching both, efficacy and safety compared to the gold standard substances such as low dose hydroquinone and or kojic acid.

Anyhow, I do strongly believe in the fact, that -for a therapeutic effect- we still need highly efficacious treatments to resolve and manage these hyperpigmentation conditions: Chemical Peels in combination with bleaching substances are a very potent way to treat melasma. It`s either about raising the concentration of the working agents or about performing multiple treatments.

Overall, the physician has to have a broad experience in combining those agents and secondly, the patient needs to be educated on following a life-long "skin-diet"-program.

Embezzlement & Employee Theft Can, And Probably Will, Happen To You.

Employee embezzlement and thefts are the most common crimes in any cosmetic practice... in fact, it's pervasive.

Believe me it can and it did happen to us. It’s still hard to believe that I saw the evidence and ignored it because I just could not believe what my eyes were seeing. Instead of going with my gut instinct I listened to a mountain full of lies from my Physician Assistant so the first lesson learned is trust what your eyes are seeing and rely less on distracting noise.

When all was said and done, our P.A. had stolen over the course of just 14 months, more than $200,000 in Botox, Fillers and Laser Treatments. 

How was she able to accomplish this?  The theft occurred in three primary ways.

1. With Botox/Dysport she would mix the proper dilution of 2.5 and then draw out a full syringe of properly diluted Botox and re-inject another syringe of saline. She would then take the syringe of Botox and put into her mini-cooler posing as a lunch box which she brought every day to keep it cold and then treat patients out of her house. The evidence of this was apparent with patients complaining of poor results. She would cover herself with some inventive lies such as; Botox out too long and I did not want to waste it, the refrigerator was not cooling to proper levels, she put the Botox in the freezer and the solution crystalized and weekend the Botox, I may have accidently put in too much saline and I used Dysport and it does not work as well as Botox.  Looking back I can clearly see the evidence but listened to her lies and excuses.
2. On fillers her number one excuse was that the product “leaked” while injecting and she was forced to use another syringe. Other excuses were the patient had a bad result so to keep them happy she offered a free syringe, a reaction that forced her to remove and re-inject later and I threw in some free syringes because she bought a package of Fractional Laser Treatments.  Most of the time, she was simply pocketing the syringes to again inject patients of our practice at her house.
3. Watch you consults and close ratios. We have been in a bad economy so this was hard to gage.  She would “feel” out the patient during the consultation and those who she believed would be players she would offer discounts for Fractional Laser, IPL’s, Matrix etc. if they paid her directly in the room in cash. I was tipped off by this from a competitor who called me and told her one of their patients told them about this. After firing my P.A. within weeks we had identified 36 patients who paid cash in the room.  She told those patients she was the co-owner so it was ok to pay in the room… To add insult to injury we had to complete their treatments as well.

The Medical Spa Embezzlement & Scams Report

Download the new Medical Spa Embezzlement & Employee Theft Scams Report 

Submit your own story about medical clinic embezzlement or theft here

After having gone through this we put in some practices that I wish we had done all along.  We now perform a Botox and filler audit every Friday. Every unit of Botox is logged onto a log sheet by patient and same for fillers. If we are off by more than 5% I will meet with my NP to go over the discrepancy.  On lasers shot counts are logged for every patient. As an example if Mary comes in for a Fractional Laser Treatment and the beginning shot count was 45,000 and ending shot count was 45,400 then the next patient for the same treatment should begin at 45.401. We also now provide to each patient our policy of ONLY paying for services at the front desk during check out.

I was also amazed to find out that every staff member suspected what was going on but was afraid to say anything because they did not want to cause any problems if they were wrong. Lastly review your insurance policy for theft coverage. I was mortified to find that ours only covered $10,000 which left us loses of about $200,000.00. We were able to absorb the losses but many others might have been forced to lay off staff or worse go out of business. As a non-physician owner I trusted far too much that a professional medical practitioner would not steel. I now understand all too well that the white coat which commands respect could also have hidden prison stripes and to use my eyes and cover my ears…

Update on 2012-07-25 18:41 by Medical Spa MD

Update: We're going to compile a report on embezzlement and employee theft in medical clinics.

If you have a story about an employee of fellow staf member who was stealing or embezzling, please help us all by submitting that story here: Submit your story about medical clinic embezzlement or theft:

Personally identifyable information so you can submit this story anonymously. 

Microderm + Chemical Peel Giveaways As A Marketing Tactic

In our Canyon Lake Med Spa practice, we are always looking for ways to attract new patients, and to give existing patients a “value-added” service. 

We’ve been doing microdermabrasion and chemical peels for many years. April Turner, our medical aesthetic RN, discovered that the 2 procedures done together were mutually complimentary, and could be performed with a minimal amount of time and material cost. We charge $99 for a combination treatment of a microdermabrasion and a medical-grade chemical peel, and do fairly well at this price. But since it is quick and inexpensive to perform, we decided to also make this a “giveaway” at our seminars and marketing events.

This strategy has served us well. We give away this combo treatment to anyone who attends one of our events, or anyone who comes into our surgical or Medical Spa office for a consultation. Some people don’t take advantage of it, but most do. And most of the time they are so happy with the outcome that they follow up the complimentary treatment with regularly scheduled (and paid) future treatments.

We found that this is a great way to attract people to our Med Spa and surgical office events, and it creates an additional revenue source for our business. If you perform these procedures at your facility (and chances are that you do,) you might want to consider this approach for your business.