Survey: How Efficient & Productive Is Your Medical Clinic?

The New Clinic Efficiency & Productivity Survey

As part of a new course we're building for the new Training Academy, we're looking into how clinics and medical practices operate, and how efficient and productive they are.

The new course? The Ultimate Clinic Operations Blueprint.

Please take a moment and answer 9 quick questions on your clinic's productivity and efficiency. It should take just 2 minutes and we'll send the results to all participants.

Take the survey right here.

Contribute to Medical Spa MD

The New Medical Spa MD Academy: Clinical + Business Training For Physicians

A few months ago we started thinking about how we could add more value for Members - and we came to the conclusion that there was a lot more we could do to help you. So we decided to bite the bullet, roll up our sleeves, and build it.

This is kinda a big deal... so cut us a little slack if we sound a little giddy.

Until now, we've focused on building what is essentially a somewhat 'soft information' community built around the blog and the forums. It's worked incredibly well. We've gown into a vibrant community with thousands of members, millions of page views and unique visitors, there have been millions dollars exchanged through the classified ads (lots of 'millions' in this post), and we've helped many Members find info or answers that have grown their practice or save them from making mistakes. (Just read some of the testimonials on the Join Us page.)

We're going to keep all of that. 

But we're adding something new: An incredibly powerful training platform.  : )

Over the last few months we've been heads-down building out an entirely new technology stack and some amazing new capabilities. We've been polishing code and tweaking copy. Our testers have run through more than 100 usability trials and security tests.

The result: We're launching the Medical Spa MD Training Academy — real-world courses for Members will provide clinical and business training for our Members.

(The first course: A Botox and filler injection course taught by Marc Scheiner MD, a Certified Allergan Trainer who has already trained hundreds of clinicians.)

Now, a physician who has spent years training clinicians a few at a time, can take that training and make it available to any clinician, anywhere, at any time. And it all happens auto-magically.

It's as easy to train a doc in Mali or Singapore or Toronto as it is to train them in your clinic.

And online clinical training works — something we learned from our friends at http://MedMastery.com who teach online clinical courses on Cardiac MRI, ECG, Epidemiology, Coronary Angiography and Transesophageal Echocardiograpy... all of which will earn you CME.

For clinicians, there are real benefits for learning online.

It used to be that you'd pay Dr. Scheiner $2,000 for a two day training. You'd have to pay for your travel. You'd have to pay for a hotel. You'd have to bring your own patient. You'd miss a couple of days of income and you'd spend those two days looking over the instructors shoulder trying not to miss anything and remember everything that you were seeing. (The old see one, do one, teach one.)

And it was still worth it.

But now it's easier.

Now, you spend a couple of hundred dollars for an online course. You can watch the trainings over and over and refer to them at any time. You don't have to worry that you'e missing something. You get every file, video and lesson in one place.

And there's a 30 day money back guarantee so there's zero risk.

What's not to like?

But there's much more to this than publishing a single course.

The 'light bulb' moment was when we realized that all of the expertise we would ever need was already here on the site. You. Thousands of Members with - we're guessing here -  hundreds of thousands of years of experience. You guys - in aggregate - know pretty much everything there is to know about clinical cosmetic practice.

If only there was a way that we could help you extract those skills and knowledge, design a beautiful course that would be available to anyone, and supply you with a massive audience of potential buyers.

So that's what we built: A new training platform and perfect target audience that's going to allow you to take your clinical expertise or business savvy, and create an awesome course that will be seen world-wide.

It's the best deal we could possibly think of.

It removes all of the risk that has stopped you from doing this on your own. You'll build your credibility, personal brand, visibility and influence, and you'll make money every time your course sells.  : )

And there are no preconditions other than they provide massive value for our Members.

If you're a clinical trainer. If you've given a clinical presentation. If you're a consultant that can teach clinicians something of value. If you're a clinician who's discovered a new technique. If you're a savvy operations manager who can improve a clinics consultations. If you already have a course that you're teaching offline, or if you think you might be able to build a course that will benefit our Members, we want to chat.

So here's what we'd like you to do: Take a look at the new Training Academy and read the "Become and Author" page. (links below) Then contact us and tell us about your new course. If we like it, we'll help you build it, market it, and put it in front of  hundreds of thousands of potential buyers who want to know what you can teach them.

Let's get started.

The Physicians path To Effective Leadership: Humility and Will

Most physicians think that they're effective leaders but there are plenty of clinics that rely more on authority than leadership.

So what do you need to be an effective leader? Personal humility and the will to be a great leader.

Studies shows that CEO humility is positively associated with empowering leadership behaviors. They tend to connect more effectively with both top and middle management, creating a collective empowerment for the organization.

This was the result of the study examining the concept of humility among CEOs in 63 companies from China. A More than 300 top management team members and 600 middle managers were surveyed in the study.

In 2001, the research done by Jim Collins about how a CEO's humility can impact a company has been shown in his book, From Good to Great. Here, Collins shattered the concept of a supposed CEO image: charismatic, authoritative, convincing, and larger-than-life.

Collins described leaders who have both personal humility and intense will to be "Level 5 Leaders".

According to our five-year research study, executives who possess this paradoxical combination of traits are catalysts for the statistically rare event of transforming a good company into a great one.

The other types of leaders, according to Collins, possess skills to transform companies but not sustain the level of excellence. This type is not the only one that can effectively lead a company, but it is essential. An interesting question would be: Can this type of leadership be learned? In an answer, Collins shares his hypothesis about two categories of people: those who don’t have the Level 5 seed within them and those who do.

My best advice, based on the research, is to practice the other good-to-great disciplines that we discovered. Since we found a tight symbiotic relationship between each of the other findings and Level 5, we suspect that conscientiously trying to lead using the other disciplines can help you move in the right direction. There is no guarantee that doing so will turn executives into full-fledged Level 5 leaders, but it gives them a tangible place to begin, especially if they have the seed within.

Read more:

• https://hbr.org/2005/07/level-5-leadership-the-triumph-of-humility-and-fierce-resolve
• http://asq.sagepub.com/content/59/1/34

Can A Dentist Own A Medical Spa?

There's been a fair amount of angst around dentists performing Botox treatments and whether it's legal or not.

This is from a press release that was emailed to me from a thread on a LinkedIn forum:

In Illinois, for instance, only a licensed physician may own a medical spa. Under the Illinois Medical Corporation Act, a medical spa, or any entity that provides medical treatment, must be owned and operated only by persons licensed under the Medical Practice Act of 1987 (the Medical Practice Act governs the medical licensing of physicians).

In Florida, for example, anyone, including a dentist, can own a medical spa. And in Washington and Oregon, non-physicians are not completely precluded from med spa ownership if they structure the business in a particular way.

Similarly, the laws vary widely from state to state as to whether dentists can even perform medical procedures like Botox and laser hair removal, which are commonly offered in med spas. In most states, dentists are limited to injecting Botox or other injectables in certain areas around the mouth. In Kentucky and Illinois, the use of Botox and other injectables falls within the scope of dentistry as long as it involves conditions surrounding the mouth but in other states like Missouri, the law does not provide express guidance on whether dentists may administer Botox or other injectables."

Does anyone know any cases where a state has come down on a dentist who owns a laser clinic or medical spa?

RockBottomLasers.com Joins Medical Spa MD Classifieds Ads

We're happy to announce that RockBottomLasers.com is joining Medical Spa MD as a Select Partner and listing their entire inventory in the classifieds. 

Buying and selling used devices is something of a headache. There are a lot of resellers but you never really know if you're getting the best price, and there's not really anyone to ensure that you're treated fairly if there's a problem. We wanted to do something about that.

We had launched a previous iteration of a classified ads area but it came with some problems. The previous ads were free. These are not. While we moved millions of dollars in cosmetic equipment, the fact that the previous listings were free invited spammers and ne're-do-wells that were always a pain in the ass to try and keep out. We didn't want to deal with that any more so we've added a payment system to keep out the riff-raff.

This time we wanted to do it better. We wanted to benefit Members by building a system that promoted:

1. Transparency in the pricing of cosmetic lasers and aesthetic equipment.
2. Active competition and pricing between resellers.
3. Easier selling of your own equipment, either by listing it yourself or contacting resellers.

Vin Wells, the founder and CEO of RockBottomLasers.com has been around the Medical Spa MD community for more than a decade, answering comments in the forums and generally being helpful to members who are looking for inside info. So, when we started looking around for used cosmetic laser vendors to have some preliminary discussions with, Vin was first on the list of people we talked to and he readily agreed to post his entire inventory to the site.

Check out Vin's inventory of pre-owned cosmetic lasers and IPLs in the classifieds area.

We're not done. We're looking for other reputable cosmetic laser resellers who want to be part of this new program and list their inventory too. We think that by aggregating multiple resellers we'll meet our goals of more transparent pricing, more active competition, and easier buying and selling for everyone. Vendors get exposure, leads and sales. 

To list an add for your laser or IPL it will cost you a measly $10 a month. Making the ad 'featured' will add another $10. That's not bad to sell a $40k laser.

There are some other things we'e working on as well. There's a category for buying and selling cosmetic medical practices and even the ability to promote and list services or products that you're trying to get in front of cosmetic clinics.

Cosmetic laser reseller? Learn more about becoming a Select Partner.

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Gastric Bypass Balloon Pills: Allurion vs Obalon

Swallow a pill. It inflates into a balloon. You're full for four months. (Eat less = lose weight). Balloon deflates and you excrete it.

It's not available (yet) in the US but Allurion, a Boston-based startup had just gained an additional $27 million in funding to pursue FDA approval. If you're in France, Spain, Belgium,  and some other European or Middle East countries it's already available.

There's a lot of competition around gastric bypass using implantable devices, but they're most often surgical. This one's not. You swallow the pill portion, it's filled with up to 550ml over the next ten minutes, then the catheter's detached and pulled out. (Might be fighting a gag reflex here.) that's pretty much it. The "Elipse Balloon" persists in the stomach for the next four months before it deflates and is passed.

Allurion has a rival in the US with a similar balloon-in-a-pill company Obalon which has already met FDA approval. (The main difference seems to be that Obalon requires endoscopic removal of the balloon which will greatly reduce market acceptance.)

Here's a video of the Obalon Ballon in action

If Allurion is successful in the US of obtaining FDA approval as simply a weight loss device they could be adopted by cosmetic practices as a vanity treatment. (If they're only approved for the very obese the aesthetics market probably won't have nearly the penetration.

• The Allurion website
• The Obalon website

13 Things Successful Cosmetic Clinics Don't Do

Strong cosmetic practices have leadership and teams that are able to manage their behaviors, patient interactions and ways that set them up for business success. Much of what's written is about what to do, but what you don't do is just as important. H

ere's a list of things that strong and profitable cosmetic clinics (and their teams) don't do.

1. They Don't Waste Time Focusing On The Competition.

Successful clinics don't sit around worried about the medical spa that's offering lower prices or spending more on advertising. Instead, they focus on delivering on what's critical for their success; delivering perceived and real value to their patients. They understand that competitors are part of every business environment.

2. They Don't Avoid Change

Great clinics don't coast. They actively look - continually - for the changes they can make that improve their business operations and the value they're delivering to patients. Successful clinics embrace change as a continual business need and an opportunity to improve.

3. They Don't Waste Time & Energy On Things They Can't Control

Successful clinics are all about what they are doing, not bitching and moaning about why they can't win and how the competition down the street isn't fair. Instead, they focus on what they do control and recognize that their success is in their own hands - always.

4. They Don't Try To Please Everyone

Great clinics focus on a few things that they do exceptionally well. They don't try to flail away and capture every patient. They realize that you can only be the best at one or two things, and they focus on delivering exceptional value in those areas.

5. They Don't Fear Taking Calculated Risks

Success isn't given and it doesn't ever follow your business plan. It's survival of the fittest and successful practices embrace the fact that they're going to have to make smart decisions and take some risks. In fact, they know that the biggest risk is not taking any risks.

6. They Don't Dwell On The Past

Successful clinics are forward looking. They're not talking about their past successes or grievances. They're looking forward to what they can improve in the future and they embrace continual improvement.

7. They Don't Make The Same Mistakes Over And Over

Successful cosmetic clinics make (a lot of) mistakes, but they only make those mistakes once. They learn fast and are voracious in rooting out why the mistakes were made and how they can avoid them next time.

8. They Don't Resent Other People's Success

Successful clinics can appreciate other clinic's successes. They know when the're being beaten and are intellectually honest enough to know that there are reasons that the market is rewarding someone else, most often because they're doing something right.

9. They Don't Give Up After Failure

Along with mistakes come failures; a terrible Groupon, a bad hire,  a cosmetic laser that is a lemon... Every successful clinic has a long list of failures that they can point to. They can also point to what they did, and kept doing, after every one.

10. They Don't Feel The World Owes Them Anything

Successful clinics don't think that they're owed success, and they certainly don't think that patients owe them anything. Instead, they look for opportunities based on their own work and merits and work to serve patients first.

11. They Don't Expect Immediate Results

Successful clinics know that success is a journey, not a destination, and like every journey it takes time. They don't expect immediate results. Instead, they apply their skills and effort to build the clinic.

12. They Say No More Than They Say Yes

Sales reps, patients, vendors... everyone is asking for yes. Successful clinics learn to say 'no' more than they say yes. It's harder, but it keeps your head in the game and your clinic pointed in the right direction.

13. They Don't Resent Their Patients

Successful clinics don't resent patients who don't want to be upsold or balk at a price. They know that all of their patients contribute to success and that their reputation is not what they want it to be, but what their patients actually think and say about them.

How Good Are Your Patient Consultations? ... About Average.

A while ago we surveyed some of our members to tell us a little about how they perform cosmetic patient consults.

If you were surveyed and responded. Thank you. (We're still collecting responses so if you haven't taken the survey you can do so through the button below.)

We had a pretty good response, and we're looking on putting together a report to present all of the findings, but there were a few surprises. One of them was the results we received about how clinics thought that were already performing. 

How well do you think that your clinic performs patient consultations?

As you can see the bulk of the answers registered were between 5 and 9 with a few 4's thrown in. There were no 10's and nothing bleow 4.

Part of that is that we used 0 as "our consults are usless". Our bad. A consult that bad is pretty hard to actually perform, so let's look at this as though 4 - the very bottom answers- are actually the lowest. If we do that then we're left with a couple of impressions:

• If you ask yourself how well you perform patient consults and your anything less than a 9, you're probably about average. That's not great since we know that consult training can increase a clinic's profitability anywhere between 25 - 100%. You're leaving money on the table, or in the consult room.
• If you answered 9, you're probably pretty good at consults.
• If you answered 6 or below. You're going to need some help.

We're going to publish all of the results once we stop collecting them. If you'd still like to contribute and add your thoughts, you can still take the survey below.

Why Don't (Most) Used Cosmetic Laser Sellers List Their Prices?

You might have noticed that a lot of used ("pre-owned") cosmetic laser sellers don't list the price of their units on their site. They demand that you call them up and talk to them.

Since we relaunched the classified ads for buying and selling used cosmetic lasers, I've noticed that a lot (most) cosmetic laser resellers don't publish the price of the equipment they're selling.

I understand. They want to have the chance to find out what you're looking for, steer you towards their inventory, and convince you that they offer superior service in addition to value pricing.

That's fine as a sales tactic and it certainly works if you have a pretty good sales team, but it does become opaque and prevents you from doing much research to determine if a specific vendor is above market, or offering a really good deal. (The very same reasons that most cosmetic practices don't post pricing.)

So, why don't cosmetic laser resellers post their prices?

1. They don't actually offer competitive pricing. 
   The internet makes for a very efficient pricing market for products. The difference you will pay for a hard drive from Amazon or Tiger Direct is mere pennies since they're 'commodities'. Cosmetic lasers and IPLs are not quite in that category but there is a know market for these devices and all of the resellers know it. After all, they have to buy their inventory as part of their business. If you're not offering really competitive pricing, buyers will see that almost immediately and you'll loose them for others who are looking for the lowest price.
   
   Recommendation: Avoid. You're going to want to determine if their pricing is high because they actually a primer offering (below), or they're just overpriced. If you get the feeling that they're not being completely above-board, avoid them and move on. There are lots of vendors and you're going to be relying on building a real relationship that's transparent.
    
2. They consider themselves a premier offering.
   The sellers position is that they offer much more than just the machine. There's the quality of the information, the expertise and detail of the refurbishment and quality check, the guarantee and service after the sell. Every physician buyer is going to be on the phone and want to feel reassured that they're getting all of that and publishing the price just means that they're not got to get the chance to talk to that doc and build a relationship. They're trying to keep the 'tire kickers' out of their sales cycle since they probably won't win those deals anyway and they suck up a lot of time.
   
   Recommendation: Worth considering. This one might not be bad for you if you're looking for a lot of hand-holding and support. Just be clear about what they're providing. Everyone (almost) says they're a premium service. They should be very clear about what they're going to do and what you can expect. It will be up to you to discern if they are, or if they're just masquerading as one.
    
3. They don't have the specific laser they're advertising and that you're calling about.
   Sellers just want the call. They can get pretty much anything but keeping inventory is expensive. It makes a lot of sense to advertise that you have everything and if a potential buyer calls, you have plenty of options to kick the can down the road just a little until you can either buy the laser they're asking about, or switch them to something you have in stock. 
   
   Recommendation: Avoid. They're injecting themselves into your search and transaction and you won't be able to count on their recommendations. 
    
4. They're profiling you before quoting a price.
   Sellers have the internet too and they use it, sometimes while you're on the phone. They're looking you up and making a guesstimate of your practice, income and needs. This isn't necessarily a bad thing, but since you're a consumer facing business they can find out a lot of information in a very short period of time.
   
   Recommendation: Be careful and ask questions. You're going to get a vibe based on where the conversation goes. If you think that they're not being honest or forthcoming in any way.. probably best to end the conversation and find someone else.
    
5. They're just being lazy.
   Keeping pricing up to date is something of a headache, especially if you have a lot of inventory. Just throwing up a few stock photos of a XEO or Starlux with a "call for pricing" message is easy.
   
   Recommendation: Avoid. Something's not right here if they can't get their act together enough to actually manage their own inventory. Probably not someone you can rely on to go the extra mile.
    
6. They're running a link farm.
   Some of the larger resellers have many sites for the same business. They do this to try and generate a lot of leads by dominating the search engine rankings with multiple listings. In some cases they have separate phone numbers so that you may not know that you're looking at the same company. In most cases they're not really trying to hide this but it does cloud the waters since you can't really find everyone in the space who might have the device you're looking for. They're not posting prices since it's just too much work to make sure they're synced across all of these sites.
   
   Recommendation: This isn't really unethical but it is confusing, and it can be expensive. These companies are usually larger which means that they are more difficult to negotiate with and it's more of a transactional relationship.

Should you look for cosmetic laser resellers who post their prices?

In general I would say yes. While there are a lot of resellers and your experience will depend largely on the individuals you're dealing with, there are worthwhile reasons to feel more confident with the increased transparency that being able to see the actual price before you contact them. Here are two examples of cosmetic laser resellers who show their prices:

• Rock Bottom Lasers in Phoenix Arizona - Owner: Vin Wells - A smaller hands-on reseller with a great reputation but not the sexiest website. Vin has run clinics in the past and is extremely knowledgeable about running a clinic in addition to cosmetic lasers.
• Sentient Lasers in Kamas Utah - CEO: Chris Cella  - Sentient is a somewhat larger vendor that also has a great reputation.

Note: Medical Spa MD has no financial relationship with Rock Bottom Lasers or Sentient Lasers. We just like these guys and they have good reputations.

Do you have a cosmetic laser, IPL, or other equipment that you want to sell? You can contact a laser reseller or you can sell it yourself on the classified ads site for members at http://ad.medicalspamd.com

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Revance: New Botulinum Toxin Moving on to Phase 3 of Clinical Trials

Just what we need. Another Botox competitor and the sales reps that go along with them.

There's a reasons that all of these companies are launching botox competitors... As a collective, Botox is the biggest money-maker in the injection market by a long ways. 

Here comes another one: Revanace, who promises longer duration than Botox. You can take a look a the company website here

Revance Therapeutics, Inc. (NASDAQ:RVNC), a biotechnology company developing botulinum toxin products for use in aesthetic and therapeutic indications, today announced the completion of its Type B / pre-IND / pre-Phase 3 meeting with the U.S. Food and Drug Administration (FDA) regarding DaxibotulinumtoxinA for Injection (RT002) for the treatment of glabellar (frown) lines. 

In this trial there were five different groups for testing for 268 subjects. There were subjects for 20U, 40U, and 60U of daxibotulinumtoxinA, participants for 20U, and some more subjects for placebo.

In Week 4, daxibotulinumtoxinA was still at 100% efficacy rate among the participants. The determinant was the Investigator Global Assessment - Facial Wrinkle Severity (IGA-FWS) scoring, in which most participants from all groups gave a 1-point improvement. In the end, the daxibotulinumtoxinA shows greater efficacy with 40U as compared to onabotulinumtoxin 20U treatment 8 to 20 weeks post-injection, even attaining 2 more points on the scale. It was well tolerated and showed longer duration.

daxibotulinumtoxinA seems to show more its efficacy and shows potential a competitor of the big three botulinum toxins. Revance might give the current competitors a run for their money, however Botox Cosmetic, Dysport, and Xeomin are trusted brands. Revance’s product is at Phase 3 trials and the trial is estimated to finish December 2018.

There's another competitor in the same state: Daewoong’s NABOTA currently undergoing clinical trials to receive FDA Approval. The daxibotulinumtoxinA aims to treat such as wrinkles, cervical dystonia, and plantar fasciitis. Clinical trials for the latter two treatment areas are also undergoing.

What 2016 Cosmetic Medicine Stats Mean For Your Clinic

Stats from 2016 are trailing indicators of the market but they should give you a clear view of where cosmetic medicine is headed.

When you're looking at where cosmetic medicine is headed, you'd do well to keep up with the latest stats showing that nonsurgical treatments are on a path to overtake cosmetic surgery in total dollars spent. 

If you look at some of these stats you'll sees some obvious trends, and that should make you think about what kinds of treatments you might look to ad or promote. Nonsurgical is where the growth is.

Nonsurgical cosmetic medicine's growth is accelerating according to the International Society for Aesthetic Plastic Surgery's (ISAPS) annual statistics.

Take a look at this chart of nonsurgical treatment's growth in the US, and compare that with the growth in surgical treatments. IPLs, cosmetic lasers, Botox and injectables.

Download and read the ASAPS report here.

The International Society of Aesthetic Plastic Surgery (ISAPS) 2016 Stats

Read the ISAPS report here

If you're not practicing cosmetic medicine in the US, you might want to think about starting a clinic in Brazil.

In the report, Brazil and the US trade top spots depending upon the proceedure. They're neck and neck, except when the treatment is further South. Brazil is almost double the total number of treatments in both Labiaplasty and Vaginal Rejuvenation than the US. (Interstingly, Labiaplasty worldwide had the greatest increase in treatments year over year at a massive 45% increase.)

The US has far more nonsugical treatments due to greater market penetration of cosmetic lasers and IPLs.

Here's a breakdown of nonsurgical treatments wich shows wider spread than if all cosmetic treatments (including surgical) are included.

Total Nonsurgical Procedures by Country

Here's another chart that gives a little insight into the macro trends around injectables worldwide.

Year-to-Year Comparison of Injectable Change

Winners? Juvederm, Restylane, Belotero Balance and Sculptra Aesthetic. Loser? Radiesse.

Implications and takeaways for your clinic

Non-surgical procedures continue to grow at a steady. No surprise there, but there are some areas of interest if you're looking at adding to your treatment menu. You really want to ride a wave that's growing and a careful reading of these types of reports can show you where that wave is headed.

The fastest growing cosmetic procedure of all? Labiaplasty, at 45% year over year growth. That's a pretty damn good indication that there's a lot of demand. 

The non-surgical options using RF and fillers for vaginal rejuvenation has just started to trend, but it's dramatic. You might want to take a hard look at adding vaginal rejuvenation to your treatment lineup.

More non-surgical procedures may continue to progress and develop, as dermal fillers and Botox are not limited to the use of the face. Lasers and IPL also contribute to the increase as they are considered non-surgical alternatives for fat reduction or skin rejuvenation. It is expected that in the coming years, there may be a spike of numbers coming in from the younger and middle age demographic.

Dr. Sarah Cenac Jackson - Audubon Dermatology, New Orleans

Part 1 of our interview with Audubon Dermatology in New Orleans: Dr. Jackson tackles the medical technologies used in their practice and her experiences as a Dermatologist.

Name: Dr. Sarah Cenac Jackson
Location: New Orleans, LA
Website: http://audubondermatology.com/

Of Interest: Dr. Jackson is a member of the Annenberg Circle of the Dermatology Foundation, the largest foundation of dermatologic research in the country. She lives in New Orleans, LA with her husband Konrad and their 3 children Adelaide, Henry, and Charles.

What sparked your interest in offering cosmetic medicine?

Botox and Restylane were FDA approved for cosmetic use when we were in training at a program that had an established cosmetic training clinic and education in place. It was a natural fit for us to continue using and perfecting our techniques with injections.

We have several leaders and mentors within the cosmetic field in New Orleans and we were inspired to stay at the cutting edge of this exciting time in dermatology. What keeps us in cosmetics is the high level of patient satisfaction with these procedures. People love looking better and it translates positively to other areas of their lives. The constant positive feedback stimulates a desire to continue training and offering our patients the best services possible.

What are the IPL and lasers you use? And how do you select the medical devices in your practice?

We use many lasers and energy devices. We started out by renting a hair removal, vascular, and resurfacing devices. As we became more booked up on the days we rented the lasers, we made business decisions to purchase devices. IPL and laser hair removal were our first purchases and remain very profitable.

We determine devices to purchase based on 1) demand 2) data on the device's success 3) profitability.

Consumables and warranties can become very expensive so we are sure to factor that in as we make purchase decisions. We calculate ROI per hour on devices including the time required for one of the doctors or aestheticians to operate it, including numbing and consents. More complicated and painful procedures have a cost to us in time!

Our Palomar IPL, Exilis radio frequency, and Cutera Hair Removal systems are fantastic because they require no numbing and have no consumable. Cool Sculpting is very popular as well. We do research to see how much competition we have locally with a particular technology, but we have found that our patients are very loyal and respect our expertise, so it has not been a big problem for us to compete with med spas or group-on type pricing.

Clear and Brilliant and Fraxel Dual are also very popular, but difficult to use in New Orleans in the summer as we have so many tanned and skin of color patients. We are starting to use Cutera's picosecond laser for pigment as it is more color-blind.

Our tattoo removal business has not been as busy as we had initially thought, but it is growing and we love having the picosecond technology as indications for that device grow.

Over the years we have become savvier about negotiating. We usually decide what technology we want (skin tightening, resurfacing, etc.) and then research which device by talking to other KOLs and peers. At meetings, we try to have meetings with laser companies and get to know their personality. We always, always demo the devices before purchasing. Prices are negotiable and we discuss extra warranty years, extra consumables, and what to do if the device is upgraded before ever signing.

What anecdotes can you share about your patients?

I think some of the worst patient situations that happened involved syncope secondary to patient anxiety about needles. As a physician injecting all day long, we need to be skilled in recognizing syncope and pre-syncope and be able to best treat our patients. We have had several episodes in the office of seizure-like activity as part of syncope. We have had patients jerk with these convulsions while a needle is near the globe and even fall off the exam table. One patient even had lateral nystagmus. After consulting with our Neurology colleagues, we learned these symptoms can be seen with syncope. We have found it very helpful to know the proper recovery for syncope. Most importantly to lay the patient flat and let the blood flow back to the brain. We keep juice and ice on hand and everyone in the office is ready and prepared in case it happens. People are not allowed to leave until fully recovered. We have had a young male patient try to leave to early and face plant the copy machine on his way out! So, we triage for this as part of the patient intake. “Have you ever passed out with needles?” We are always prepared with guarding the needle and stabilizing our hand in case the patient jerks. We have our staff prepared so the patient recovers fully and can have confidence in our care.

Bio: Dr. Jackson received her medical degree from Louisiana State University School of Medicine, where she was a member of AOA honor Medical Society. She also fulfilled her residency training at Louisiana State University Health Science Center where she served as Chief Resident in Dermatology. She received her undergraduate degree in Zoology from Louisiana State University, where she graduated cum laude. She is a board-certified Dermatologist with special interest and training in medical dermatology, dermatologic surgery, cosmetic dermatology and laser surgery. Dr. Jackson is a former President of the Louisiana Dermatological Society. Additionally, she served for several years as the Louisiana State Chair of the Dermatology Foundation. Dr. Jackson is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery and the Women’s Dermatologic Society.

Dr. Deirdre Hooper - Audubon Dermatology, New Orleans

Part 2 of our interview with Audubon Dermatology in New Orleans: Dr. Hooper of discusses marketing strategy and staffing.

Name: Deirdre O' Boyle Hooper MD
Location: New Orleans, LA
Website: http://audubondermatology.com/

Of Interest: Dr. Hooper is half of of Audobon Dermatology. She's an executive committee member of the Women’s Dermatologic Society, the nation’s 3rd largest dermatologic society. She also serves as Financial Vice Chair of the Women’s Dermatologic Society’s Legacy Council.  

Dr. Hooper lives in New Orleans with her husband and their 3 children.

Kindly give us a background of your clinic.

We have a condo in a medical office building across from a hospital. Being in a medical setting allowed us to become busy very quickly based on referrals from other doctors in the building. We offer a full range of medical, cosmetic, surgical, and laser dermatology. Treating medical patients over the years has fed our cosmetic business-for example, the mothers of our pediatric acne and wart patients become our injectable patients, and they often send their husbands to us as well!

We rented lasers until it became financially more sensible to purchase our own. We now each see about 35-50 patients each per day and have 2 full time aestheticians, 2 nurses who assist with cool sculpting and aesthetic procedures, and a skin care concierge. One of our early hires as an aesthetician has a business degree. As we have grown the practice, she has become more involved in the business and HR end and has now become our office manager.

We are committed to making sure that each and every patient is confident in our care. This means that we will take care of you every step of the way, whether your journey includes skin cancer surgery, skin diseases, lasers, injectables, or anything in between for a high-tech natural rejuvenation. At Audubon Dermatology, we specialize in comprehensive dermatologic care for all ages, skin types, and skin conditions. We utilize a wide array of the most innovative products and procedures to give you the best care possible. We are located in New Orleans but often have patients coming in from around the country to receive our services.

How do you approach staffing in your practice?

We offer quarterly bonuses that incentivize the office goals and behavior we want to achieve. We feel like it’s a great way to positively reward great employees and check in more frequently with employees who may still be learning. We have a policy that employees may not request a merit increase until they have improved on their evaluation scores for 3 consecutive quarters.

It’s important for employees to experience and try the products and procedures in your office so that they can recommend them to patients. However, we have found that not all employees utilize procedures, or they may not understand the value of a procedure or product when given absolutely freely. We offer "Audubon Bucks" quarterly based on very simple and specific measures we expect every employee to complete. If employees call in sick multiple times or are not completing items on their detailed job descriptions, they lose their Audubon bucks, we have found this to be an effective way to avoid giving free services to less effective employees, and to be a great way to allow employees to see the costs and value of services we offer.

Hiring and Firing seem to be the most common struggle we and our colleagues face. We have learned 3 important points: 1) Hire experience for the back, personality for the front. 2) Hire people that you personally like and would enjoy spending time with outside the office. 3) Incentives are not only monetary-appreciation and acknowledgement are just as important.

What are your marketing strategies?

We find that word of mouth is our biggest referral system. We rarely pay for advertising but do focus on our social media. The marketing world is changing, we are constantly trying to grow our online presence.

When we started our practice 10 years ago we had a yellow pages ad. That is long gone as we implemented a tracking module in our EMR and started tracking-how did you hear about us? 95% from my friend or another physician! In recent years, the number of patients who find us by google is growing, so we are sure to keep our website updated and search-friendly and we are utilizing social media, mainly Facebook (including Facebook live), Instagram, and twitter.

We use Constant Contact to email patients about specials and new services. In our office, we have discreet signs on the back of every door mentioning current specials and customized cards that give an overview of products and services we offer for varying cosmetic complaints such as red face, fine lines, or pigment problems. These often generate questions as patients read over them as they wait for us.

We have tried newspaper ads, ads in local magazines, even billboards. None of these have approached the success of internal marketing and social media.

What procedures are most performed in your clinic?

We try and focus on treatments that make a clinical difference. We are always bringing in new devices or products. Staying on top of all scientific and technological advances in skin care and device modalities has been a priority of ours from the beginning. We do track our ROI and if something is not selling we phase it out, but typically that goes hand in hand with new advances that we are upgrading to anyway.

What pearls and tips can you give fellow physicians?

One important lesson is not to let the patient tell you what to do. As we begin in cosmetic medicine, we may want to please the patient, and go against what we judge to be the best cosmetic outcome. We have learned that the patients are there for our expert injections, and also our expert eye. We know what looks best, and they benefit from our knowledge of beauty. Many patients come in and say “whatever you think, Doctor”, but unfortunately not all of them. For those patients we try to educate them, and offer them our best plan for a great outcome. If they cannot see our way, we do not inject them. You want as an injector to be proud of every patient that you work with. Be selective and always stick with what you know is best!

Bio: Dr. Hooper is an honors graduate of Louisiana State University School of Medicine. She received her undergraduate degree in biology from Louisiana Tech University, where she graduated cum laude. Her postdoctoral training included Louisiana State University Department of Dermatology as well as a Women’s Dermatologic Society Mentorship with Dr. Pearl Grimes in Los Angeles, CA. Dr. Hooper is a Board-Certified Dermatologist with special interest and training in medical dermatology, dermatologic surgery, moles and melanoma, cosmetic dermatology and laser surgery. She is an executive committee member of the Women’s Dermatologic Society, the nation’s 3rd largest dermatologic society. She also serves as Financial Vice Chair of the Women’s Dermatologic Society’s Legacy Council. She is a member of the American Academy of Dermatology and has served on that organization’s Youth Education Committee. Dr. Hooper is also a member of the American Society of Dermatologic Surgery and Louisiana Dermatology Society. Dr. Hooper lives in New Orleans, LA with her husband and their 3 children.

Cutera Reviews: Buying Used Lasers & IPLs

Cutera is a major player in the cosmetic space with a number of platforms and systems:Cutera Coolglide, Cutera XEO, Solera Opus, the LimeLight IPL, ProWave Nd:YAG and Solera Titan. So what's Cutera's reputation with physians?

If you read the discussion threads on Cutera there are some positive opinions about the technology but there's a a lot of negative reactions to the company policies around sales and support practices. Much of it mimics these opinions in the comments on this Cutera discussion thread from way back in 2007: Is any Cutera technology work buying?

Many of the comments or reviews fall in to a couple of buckets that are recognizable and are often repeated; problems with the effacacy, pricing and costs too high, buyer felt lied to or misled by the sales rep (oversold and under-delivered), and the companies desire to lock in the buyer and extract every possible dollar. (We're working on series of posts and a guide to address all of these areas.)

Cutera's not the only laser manufacturer facing some negativity of course. All of the cosmetic laser companies have some issues that they deal with all of the time. In some cases it's unrealistic expectations from buyers but there's a lot of sales reps that aren't doing these companies any favors in overselling and promising revenue outcomes that are much more dependent on the buyers business sense and marketing that the IPL or laser they're buying.

Don't Buy New comments:

I'm new to this site and so happy to see that I'm not alone. Recently wooed into purchasing the Cutera Excel V (at a conference) BIG mistake. Free drinks, good salespeople, and me-new to industry, naive and inexperienced with lasers and zero business savvy. I was told by the speaker at the event, who was also a friend of a friend who I thought had my best interest in mind, that I was getting "the best deal the salespeople are allowed to give" for the demo unit at that conference. Paid $125,000, it broke on day of training and then 2 more times over next few months, and I did not see the results I expected. Long story short...after 6 months of minimal use, I am trying to get rid of the laser, have been offered $30,000 by 2 different laser re-sale companies! Called financing company Cutera had me sign with-Heartland (no options given and no discussion of terms) who informed me that my payoff is actually $170,000 with no ability to pay less early! Can't resell on my own because warranty doesn't transfer unless I pay Cutera another $30,000 to transfer ownership.

and from LH

... The only Cutera piece I still use is the 1064. I will never buy new from Cutera again. I may buy a used 1064 for 20 cents on the dollar or less. The secondary market is very crowded with Cutera products which continues to devalue them.

but one anonymous poster (sarah) said this:

As a Cutera owner I am shocked to stumble across this site. I have been working with this system 2 years. I have very satisfied patients, many of them are thrilled with the how much better the 1064 works for hairs than other treatments they have had elsewhere.  There the no equal to the 1064 for safely treating facial veins.
Also, anyone who is not getting great results with the Titan is just not doing right. I have people coming over from Thermage all the time. Just prepare your patients, doing this treatment to get great results comes with a lot of discomfort. 
Anyone complaining about a warranty... should have bought it at the beginning. My sales rep is amazing, we can always count on him to support our events and set up extra training whenever we feel under prepared.

In short, We love our Cutera system! It just took learning how to use it correctly.

My impression in reading Sarah's comment is that she is not the owner of the clinic or buyer of the system. (Just a hunch.) Most buyers are always talking about the business costs vs return rather than the personality of the sales rep.  : |

Notes: We allow anonymous comments on this site for obvious reasons but you might want to judge the voracity of those comments vs commenters who are identifying themselves (which you do when you login and comment.) All comments are individual opinions and don't necessarily reflect the views or opinions of others on the site. Make your own decisions.

Anyone have thoughts on the current state of Cutera's technology or sales practices?

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