New Dermal Fillers For Your Medical Spa.


The new Revanesse Versa and Teosyal RH fillers add to the growing list of available injectables.

There are a couple of new dermal fillers currently making their way into the cosmetic market in the US: Revanesse Versa, Teosyal RHA2, RHA3 and RHA4.

Revanesse has been in use since 2002 (Revanesse USA, 2018), while Teosyal has also been around for some time in Europe. They both (Revanesse Versa and Teosyal) now have FDA approval they've made their way into several clinics in the United States.

There are more than 30 dermal fillers allowed for use in the US, which makes for a crowded space. In many cases the differences between fillers in a specific product line or across competitors really boils down to user preference around viscosity, ease of use, name recognition in your patient population or any number of things. But... competition is good and just because you're comfortable using your Restylane or Juvederm line doesn't mean that you may not like something just a little better, even if it's only to allow you to reduce the price for your patients. Revanesse and Teosyal's addition to that line should give you some more tools.


Revanesse claims that it causes unwanted swelling less often that other HA formulations on their website.

"In a recent study another popular (HA) dermal filler was shown to produce swelling 24% more often than VersaTM. Our lower rate of swelling means many patients are able to get back to their lives almost immediately after the treatment."

In the clinical trial of Revanesse Versa 163 people participated in the study. Most injection-site adverse effects were either mild or moderate. The comparator group showed more reported filler adverse events, with an accumulated incidents of 553 events, while Revanesse had only 378.  Post-injection, 114 subjects experienced adverse effects, while 137 participants experienced effects with the comparator dermal filler. Swelling was considered a serious side effect, however, patients who have been injected with Revanesse also complained of swelling. (The feedback was from a patient review site.)

Researchers also conducted a retreatment addendum. Those who received retreatment experienced only mild to moderate adverse effects including hematoma, pain, and swelling. More patients experienced those effects seven to thirty days post injection.

Findings: Reported Frequently Injection-site TEAEs (for the first study):

  • Erythema = 35/163 = 22%
  • Hematoma = 82/163 = 50%
  • Pain = 62/163 = 38%
  • Swelling = 77/163 = 47%


Teosyal has a number of different fillers in its product line in the EU but it's only the RHA series that is currently approved in the US. Teoxane fillers have been examined in several studies, however there is so far one study about the RHA line showing efficacy - the filler line lasted for 6 months for the study participants (Rzany, 2018).

The Teosyal website doesn't make much in the way of claims of differentiation from other fillers but it's hard to say if it's just because they're a 'me-too' product or they don't have the data to them.


Aside from these two dermal fillers entering the US Market, it was announced that Allergan will acquire Elastagen’s product for $95m as part of their new injectable line, and that may change things even more. Elastagen uses Tropoelastin which has been studied in wound healing and skin repair. The potential for aesthetic use is right alongside and Allergan has probably done a lot of due diligence on Elastagen's efficacy and patient results. 


New Medspa Opening? What should I do?


Here's an email that we received a while back that is typical of where physicians new to the cosmetic space start - buying a cosmetic laser or IPL and then trying to figure out how to pay for it.

I am a newer reader and now subscriber to MedicalSpa MD. By the way great content!!

My wife's (Ob/Gyn) practice has recently purchased Syneron Emax and VelaSmooth equipment to begin their aesthetic practice within their Ob practice.

So now that the $$$ has been spent we are working on getting our Marketing, brochures, website etc together to begin to establish an image, look etc. and begin to take customers.

While you name several MedSpa www sites that have problems, do you know of any MedSpa sites that you really like?  We would rather not reinvent the wheel and if you might provide a few good www sites we might reference as starting points it would be much appreciated.

Also, I realize you are very busy, however, I think a "Top 10 list of things to avoid" in the MedSpa business or the "Top 10 things to do before you buy your aesthetic equipment" would be very helpful.  We just kinda jumped into this market and well as they say... now here we are.

I'm not going far out on a limb here to suggest that this probably sounds really familiar to a lot of clinicians who are just starting out, and to existing cosmetic practices who see competitors popping up around them.

So, we're going to break this down by parts and see if we can't provide some feedback that can help. In fact, we're going to make this part of a series of posts that pulls apart the hopes and false assumptions and injects both some hard realities and some tactical advice that you can put to work ASAP.

NOTE: If you have some questions like this, use the contact form and ask them. We'll do our best to answer your questions since there are others that also have them. (You will not be identified in any way so don't worry that your name or clinic will appear in a post.)

The Accidental Medical Spa

It's obvious from the first sentence in the email above that the spouse has been assigned the task of doing some 'market research' after the fact. It's not uncommon to have a spouse, office manager, or even a trusted friend take on the role of 'startup consultant' and try to bring some clarity to the chaos of trying to start a cosmetic practice inside or alongside your existing clinic. In a lot of cases the physician just wants someone else to do it and tie it up in a bow. After all, they're already working full-time in the practice that is paying the bills.

While I think there are better ways to approach a new business there are also some actual benefits to doing it this way. (Note that I'm not recommending this.) At least it causes you to focus in a way that gets you involved and problem-solving. After all, you now have laser payments to make and if you don't figure out things toute suite, you're in for a big loss. It has the effect of forcing you to pay attention and make some decisions. In the best cases you learn things quickly and make some smart decisions. In the worst cases you lose your shirt and sell your new lasers with a 60% loss which is a really painful lesson. In either case you're getting an education and you're paying for it.

More from the email: "So now that the $$$ has been spent we are working on getting our Marketing, brochures, website etc together to begin to establish an image, look etc. and begin to take customers..."


That's the sentence that really stands out more than the others. It's clear that - since the physician is an OB-GYN - the cosmetic portion of the practice is going to target the existing patient population, but once you start buying lasers you're on the hook for those payments one way or the other. It would be really nice if you knew that the demand was there before those payments start, and there are ways to do that. 

So what would I suggest?

If you're a physician who's thinking that you could bring in some additional revenue doing Botox and filler injections and getting a laser or IPL and selling those services to your current patient base.. well, you're right. IF you're smart.

First - and this is critical - sell the treatments before you have to deliver them.

It's not hard to do and you'll learn a lot.

The very toughest sales for everything you will ever do are the first ones. If you can make the sales you'll lower the risk and sleep easier at night knowing that you're going to be able to make your payments. Most physicians ask their current patients IF they would pay for something like Botox or stretch mark reduction or whatever... the real trick is to "presell" the treatments. The only real responses that you can trust are when a patient actually buys from you. That's the ONLY real test.

Here's how you do it:

  1. Announce to your current patient population that you're going to launch a new service; Filler injections or whatever. Don't position this as "I'm thinking of this, what do you think?". Just proceed as though you're doing it with a specific date or timeline.
  2. Attempt to presell the treatments or service to your existing patients. If you can't do it with your existing patients you'll find it even harder with new patients that don't already know, like, and trust you. Give them a discount for "pre-ordering" the treatment, something like 10 or 15%. (Don't make the percentage too high since you're trying to find out if you can sell it at full price.)
  3. Collect the money. The ONLY think that counts here is real sales. Do not count any "I'll buy it once you do it" stuff. Patients will always tell you that it's a great idea to offer more services but you need to know how many patients will buy it and what they will pay. (NOTE: Depending upon what the treatment is the cost may vary widely. If it's really expensive you don't need to sell as many as if it's something cheaper.)
  4. IF you're absolutely sure that this is a windfall, then actually buy the laser or add the service. If it's not clear, be very careful. Remember that you have to support every service you and and there are opportunity costs to anything you do.
  5. IF it doesn't sell, refund the buyers you have with your appologies and a small free gift (something like a 20% discount on their next filler injection or a free facial) as a thank you.

See how that works? 

You want to start collecting money before you actually make the investment and doing it this way puts you in a position to ensure that you're going to be adding a profitable service and not an $80,000 towel rack.

As always, thoughtful comments or thoughts appreciated.

Dermal Fillers: How Often Will Patients Sue You?


Everyone is offering fillers. If you're practicing cosmetic medicine for any period of time, you're going to have an occasional unhappy patient or unwanted outcome. Since dermal fillers are so popular, we wanted to take a look at how often fillers are causing problems that result in lawsuits.

Restylane, Juvederm, HylaForm, Belotero... the fillers are all here and deeply ingrained in every practice. The safety and efficacy of fillers is pretty well known and you've probably got a lot of experience already since you're performing lip augmentation and facial wrinkle treatments every day. But it's exactly the fact that fillers are so common and performed so often that can put you at risk. The odds that any individual treatment will have an unwanted outcome is really low, but since the number of patients you're treating are quite high, it's still a possibility you need to take seriously.

Here are some interesting results from studies that have been conducted in the last few years. (Links to all of the studies are at the bottom.) 

A couple of things to note here is that sometimes we're not comparing straight apples to apples. While OB-GYNs are the most common specialty to be sued, surgeons are next. If you're a cosmetic or plastic surgeon there may be a bias that elevates your risk somewhat. (If anyone has a study showing this please link to in in the comments.)

  • Medscape study, surgeons are second to OB-GYNs for being sued by the public.
  • Vila-Nova da Silva et al., 2015, breast surgery was the most common procedure filed for a lawsuit.

You're undoubtedly disclosing the possible side effects and expectations when you're doing your consultations, but there's an interesting study that correlates an expectation of the clinician with an elevated risk of being sued. The study found that disclosing all possible risks and outcomes didn't scare the patients, but that those physicians who thought so were at increased risk of a suit which is interesting. (Boyll et al., 2017) 

One of the last articles JAMA Facial Plastic Surgery published in 2017 were litigation cases filed due to dermal fillers and there is some risk of unwanted outcomes or mid-term issues; Hyaluronic acid fillers typically cause swelling and infection, while CaHA causes infection and pain, and PLLA and PMMA both cause nodules. In the study, most of the swelling were found in the tear troughs, while only infection were found in the nasolabial folds. Additionally, intra-arterial injections especially without sequelae were found in the lip and nasolabial folds (Rayess et al., 2017).

Other than this study, Ezra et al. (2015) also examined litigation earlier, and may have encountered the similar cases as with Rayess et al. (2017) back then, only granulomas were found as an adverse effect that resulted in a filed suit. 

In the Ezra 2015 study,  the real cause of most of the problems becomes clear - non-physicians who are performing the injection and there can be additional disciplinary actions in addition to a patient filing suit.

From the study: (This is about disciplinary actions, not lawsuits)

A total of 24 legal documents were identified: 19 cases and 5 disciplinary actions. Of the 19 cases, physicians were named as defendants in 13. Six of the 7 cases that named a nonphysician as a defendant involved a substance being injected different than the reported filler. Overall, 50% of legal actions from soft-tissue fillers were related to a nonphysician performing the procedure. Of physician subspecialists, dermatologists and plastic surgeons had the highest proportion of litigation (17% each); this is likely due to these specialties performing a higher volume of the relevant procedures. The majority of disciplinary actions were reprimanding physicians for not being present while a nonphysician employee injected patients with soft-tissue fillers. In 3 of the 5 reprimands, physicians were functioning as medical directors of medical spas.

The chances that you'll be sued by a patient for a filler injection treatment is extremely small unless you're doing something stupid like allowing someone who is unqualified, unskilled, or unlicensed. Be sure that you're using clinic best practices and procedures and that your staff is trained. Almost all of these problems can be avoided if you avoid the trap of thinking that any procedure is routine.



Reduce Complications after Laser Treatments with This Simple Assessment

Skin Hydration, a simple but often overlooked assessment in preventing complications after laser treatments. We are all accustom to screening for sun exposure, use of topical agents, and medication history prior to administering a laser treatment.  But we often overlook assessing for skin hydration. Lasers target specific cromophores (Melanin, Hemoglobin, and water) and deposit heat energy. Dehydrated skin will respond very differently to a set energy level than hydrated skin.  As skin tolerance is reduced likelihood of prolonged redness, small burns, and infection increase.

Conduct a simple physical assessment focused on temperature turgor and moisture level; take a quick patient history of hydration status including level of alcohol and caffeine intake. And finally, if you have a Wood’s lamp handy a quick view will provide a confirmation of your assessment.

If you find the patient is dehydrated be conservative with your energy settings. Dehydrated skin will be more sensitive and healing time will increase. Pay special attention to ablative lasers that primarily target water, you may even consider postponing their treatment until their skin hydration improves.
Educate your patient on hydration health, products to improve transepidermal water loss (TEWL), use of humidifiers in the home, etc.  Their skin will thank you as and their outcomes will be more predictable and effective.


Nancy Miller, RN MBA

Experienced Executive Director Of Operations with a demonstrated history of working in the health wellness and fitness industry. Skilled in Healthcare Information Technology (HIT), Electronic Medical Record (EMR), Health Insurance, Nursing, and Clinical Research. Strong operations professional with a Master of Business Administration (M.B.A.) focused in Health/Health Care Administration/Management.

4 Reasons You Should Never Buy Paid Patient Reviews, And 1 Reason You Should.

Patient Reviews for Cosmetic Medical Practices

You're getting emailed from companies promising to raise your profile in the search engines by pushing hundreds or thousands of positive reviews, Facebook likes and Instagram shares to your sites and profiles, driving inbound patient inquiries and filling your treatment rooms. Don't do it.

Reviews are seen as one of the most valuable decision-making credibility markers that patients use when deciding who they're going to trust with their face. In fact, 85% of your potential patients trust online reviews - if they find them credible - as much as personal recommendations from their friends and family.  There is, however, a caveat to that trust. Consumers will only trust those online reviews as long as they believe they are authentic.

Here are some survey highlights from the latest 2017 survey:

  • 97% of consumers read online reviews for local businesses in 2017, with 12% looking for a local business online every day
  • 85% of consumers trust online reviews as much as personal recommendations
  • Positive reviews make 73% of consumers trust a local business more
  • 49% of consumers need at least a four-star rating before they choose to use a business
  • Responding to reviews is more important than ever, with 30% naming this as key when judging local businesses
  • Consumers read an average of 7 reviews before trusting a business - up from 6 last year

Since the value of reviews is so high, some medical spas and cosmetic docs have taken to trying to buy positive reviews from bot-farms. Not a good idea. 

Here are just a few of the reasons why you shouldn't buy online reviews for your clinic.


The biggest reason businesses shouldn’t buy online reviews is it’s against the terms and services of many online review sites. Businesses that ultimately do buy reviews or post fake reviews on behalf of their customers could suffer legal action or face sanctions.

Yelp has been very active in trying to ensure its reviews are authentic. Its Consumer Alerts program was created to make sure its reviews are properly vetted and provide helpful, accurate information to consumers conducting online research. If a business on Yelp is found to be purchasing reviews, their profile will be tagged with a warning to consumers about the dishonest activity.

The same is true for Google and Bing. If they catch you doing this the penalty can be severe and they will bury your search engine rankings - exactly the thing you were trying to improve.


As we mentioned, online reviews are a valuable tool for both patients as well as clinics. Patients are leery of clinics either posting fake positive reviews on their sites or trying to sabotage their competition by posting fake negative reviews on their competitor’s sites. To ensure that trust is earned, your clinic should make every effort to be transparent in their collection of online reviews and run from shady practices. Patients can be merciless in spreading the fact that you're performing underhanded reviews if you're caught, and it's really easy to catch you. 

If your reviews are unerringly positive and weren't actually written by your patients - with shortcomings included - you're going to get hosed.


This one should be obvious but we'll outline it anyway. When you buy online reviews, you are lying to your patients and potential patients. Once they suss that our you're in for some through word-of-mouth backlash and deservedly so.

One thing to note here is that it's often your staff that will spill the beans. It only takes one tech or clinician to wink or drop that "those are all fake anyway" and - even if it wasn't the intent - your clinic's reputation will suffer.


When you buy online reviews, you're not getting feedback from your real patients. Reviews can help you identify problems that might exist in your business and gives you the tools needed to fix them. Clinics that are focused on the customer and care about the experience being delivered won’t need to buy online reviews or post fake ones because their customers will be motivated to post positive reviews on their own.

If you're thinking about buying fake reviews, don't do it, just punch yourself in the ear instead.


The title lied.

There isn't any reason that you should buy patient reviews, but you should figure out how to get and use real reviews from our patients. If you're looking to improve both your recommendations and your search engine results, take a look at the Podium Special Offer for Members. It's the best tool you'll find IMHO and it works extremely well if you use it. You'll also save yourself countless hours of headaches and something like $1500 if you take advantage of the Members offer. Do yourself a favor and check it out or ask for a demo.

Can't separate your clinic from every other medspa? Try This Simple Innovation Technique.


If you're not doing anything other than what every other plastic surgeon, dermatologist, and medical spa is doing you're stuck competing on only one thing; price.

And that's a straight shot to the bottom.

There can only be one lowest price in a market and the second-lowest price will always lose. Just ask Kay-Mart and Sears who lost long ago to Walmart. Worse, a patient who comes to you based on price will leave you just as fast for someone who's offering IPL, Botox or cosmetic injectables for less.

To get unstuck and find some area where you can distinguish yourself you'll first need to identify the orthodoxies and assumptions that you're already using. The most common assumptions revolve around what others are doing and especially the "we've always done it that way" lazy way of thinking.

Here's a way to tackle this. Start by actually writing down the assumptions that you have that - if they are true - would prevent you from achieving your goals. Your clinic is filled with assumptions: patients won't pay for ___, my staff can't sell, they're not motivated, I'm not good at business, everyone is doing it better than I am, I have to work 60 hours a week... you're looking to root out orthodoxies by identifying existing assumptions and overturning them to illuminate blind spots or limiting beliefs to look at your problem in a new way. By articulating these assumptions you can then attempt to test them - which is key - in order to make better decisions that actually improve  your business and lifestyle. Y

Example: Alan Robinson (co-author of Corporate Creativity) writes in his book how KC Fine Furniture trained their delivery drivers in basic interior decoration so that when they deliver furniture to the customer, they help arrange the room, and accessorize. As a result, their rejection rate dropped from 10% (the industry standard) to 1%. That simple change decreased their returns by an order of magnitude. Nice.

Assumption Reversal

Here's an example based on a process from the book Orchestrating Collaboration At Work.


  1. List all the assumptions you have about a particular topic, even the most obvious ones. Remember, not all assumptions are wrong. You just want to be explicit about them because they may hold the key to achieving a breakthrough idea. (Aim for 10-20 assumptions
  2. Write down the opposite or a modification of each assumption.
  3. Use each assumption as a trigger for new ideas, write each idea on a Post-it® Note, and place them on flip-chart paper for evaluation.

An example: Assume you are a dermatologist with a new medical spa and want to attract new patients. You might list the following assumptions:

  • My existing patients are going to competitors who are charging less for filler injections.
  • I should lower my filler injection prices to compete.
  • I will make up the loss on other treatments.

Next, reverse these assumptions as shown in the following examples:

  • My existing patients are not going to competitors who are charging less for filler injections.
  • I should not lower my filler injection prices to compete.
  • I will not make up the loss on other treatments.

Finally, use these reversals to suggest ideas:

  • Emphasize that that you're not the "Walmart" of filler injections.
  • Stress the high cost of my treatments and "you get what you pay for".
  • Give patients who recruit their friends an "insider friends and family" deal.

Source 101 Activities for Teaching Creativity and Problem Solving. (VanGundy 2005)

What assumptions do you need to question?

You're always going to see competitors as the person just down the road, but the truth is that you're competing with much more than that. The path to success is paved with broken assumptions and you need to question - and test - all of yours. If you're relying on the wrong assumptions about your market, your patient population and your business, you're driving with the breaks on at best.

Cosmetic Consultations: Patient and Physician Perspectives on Scar Appearance


There are always differences in how providers and patients see both outcomes and - when there's surgery involved - normal byproducts of the treatment like scaring. Yep, patients see scarring different than you do as a surgeon.

You're already explaining scaring and expected results, but patients commonly discount what they see as secondary effects to the primary benefits. So while the new results are something that patients quickly adapt to as the 'new normal', but the scars - even if they're minimal - stay. If they're visible they can detract from the primary benefits over time.

A new article raises patient and physician perception of how patients and physicians disagree over the appearance of scars and it could cause some differences. What causes the disagreement over the evaluation of scars? The researchers looked for studies where the Patient and Observer Scar Assessment Scale (POSAS) was present, and from there, researchers found most studies had expressed indifference towards the scars. Based on their findings, the common reason for disagreement towards a scar when patients have a favorable rating towards a scar, while physicians did not detect a difference on the scar.


  • Only 28% of the studies had disagreements toward scar appearance
  • Sixty seven percent of the patients preferred a “given surgical closure method” (Zhang et al., 2018 p. E8) than what was performed.

Additionally, there is a psychosocial effect in the appearance of scars and in the quality of life of patient afflicted with surgical scars, as Zhang et al. also briefly discussed. Many patients are unhappy with the scar that results from their surgery. Dissatisfaction and depression had been reported on patients who had facial trauma (Negenborn, 2017). It is also alarming to learn how those with facial scarring would prefer to die than live with the scar on their face (Zhang et al., 2018).

The researchers recommend that a pre-operative discussion is necessary to set expectations, and that an improved assessment scale would help in identifying and rating scars better.

Several studies have investigated in the prevention of emerging scars and eventually treating them as well. 

According to Monstrey et al., (2014), silicone sheets or gels are the most effective non-invasive remedy to treat scars post-surgery. Additionally, some physicians would recommend massaging the scar to treat it. Other known treatment options for scar treatments are fat grafting-- which proved effective for several patients (Negenborn et al., 2017; Riyal et al., 2017), laser treatments (Alberti et al., 2017; Perez and Rohrich, 2017), and even botulinum toxin (Ziade et al., 2014).

So what to do?

Make sure that you're up front about expectations post treatment, but also walk through a treatment plan to address or treat side effects like scarring long term. (Especially if the patient is prone to keloid scarring) Patients can be expected to follow very specific pathways on how they view their results and you can go a long way in elevating their perceived outcomes if you spend just a little time up front.

3 Local Marketing Hacks For Cosmetic Medical Practices To Leapfrog The Competition


Turning your local reputation into sales results is a complicated effort that every medical spa, laser clinic, plastic surgeon and dermatologist is continually trying to solve.

Many of the traditional ways no longer work. Yellow pages are dead. Newspapers have fewer readers. Tired 'discount local flyers' are less effective. Everything is turning to the mobile web. According to Pew Research, 72% of US adults use a smart phone, and the percentage of your patients are going to be higher than that. And they're using those little computers in their hand to research and find businesses on-demand - "best local lunch restaurants", "great roofing company near me", or "lowest Botox treatments near me".

Google refers to these times when people are asking for on-demand information related to purchases as "micro-moments" and they are quickly becoming the norm of many consumers. If you're not optimizing your online presence to take advantage of these moments and get yourself in front of potential patients you're missing all of those sales since you're not even in the game.

With the current tools available and the way people interact with them you should no longer be taking a spray-and-pray approach, trying to get in front of everyone. Instead, look at your metrics and see exactly where your sweet-spot is by age, types of treatments, and margins. Then examine they're buying patterns. It's probable that before you're selling the most expensive and profitable treatments that patients are exhibiting certain buying 'tendencies' that you can address. Uncover what those pathways are and then market those entry treatments to that narrow market segment. For example you may see that your most expensive laser treatments are sold to patients aged 40-45 who first came in initially for Restylane or Juvederm. Rather than market the laser first, you should really be targeting them with low cost lip augmentation or fillers.

What are marketing "Micro Moments"?

A post on Think With Google highlights some key opportunities for capturing customer mindshare during micro-moments, including:

  • Identify the top mobile searches in your area. As mentioned previously, mobile device usage is on the rise. More and more consumers are conducting searches on the go and those searches result in increased foot traffic and increased sales. In fact, 50 percent of mobile searches result in an in-store visit within 24 hours with 18 percent of those visits ending in a sale within a day. Knowing what those top mobile searches are can help ensure that your business is the one capturing those customers.
  • Know the frequently asked questions related to your business. If you know what consumers are asking about your business you can create content tailored specifically to answer those questions. For example, if you were a dentist you might want to optimize for questions like “how often should I floss?” or “do I need braces?” Helping to educate your community about issues important to them can help you build trust.
  • Know how customers find your business. Finally, it’s important to find out how customers are getting to your business. Map your customer journey and identify specific moments where customers might have questions. Doing so can help inform your local marketing strategy to ensure your messaging helps push them from consideration to purchase.

Now that you have a better understanding of how micro-moments affect your business, let’s touch on how you can use these moments to get new patients in your front door.

1. Hyper-Targeting

Look for opportunities to personalize your message when you're putting yourself in front of someone. It's now easy to collect mountains of information about customers and potential customers. You can use that info to personalize calls-to-action to make them more appealing. According to HubSpot, personalized CTAs converted 42 percent better than CTAs that aren’t personalized. The personalization need not be as targeted as someone's first and last name.... no. Social media platforms allow you to segment audience quite well, so you can address a message to 30-35 year old women to 'Soccer Mom', or 'Empty Nester" for those 50-55. Just use something clever that your target identifies will immediately.

2. Optimize Directories

One way to ensure that your business is there when your customers need you the most is optimizing your directories for local SEO. Doing so will give your business a better chance to show up in Google’s Map Pack and near the top of local search engine results pages. There are a number of simple things businesses can do to optimize for local search, but for whatever reason, they neglect to do so. They include:

  1. Claiming all relevant business directories
  2. Consistent contact info across all listings and on your site
  3. Upload high-res photos to increase attractiveness of your listing
  4. Use your blog to drive links back to your site
  5. Collect and manage online reviews

3. Build Out Extensive Online Patient Reviews

Online reviews are search engine gold. They build your search rankings, add to your credibility, and are trusted much more than what you say about yourself. A vast majority of consumers trust online reviews as much as personal recommendations from family and friends. Finally, they can help your business get chosen because online reviews have a strong influence on purchase decisions.

If online reviews are so valuable, why do many clinics ignore them? If you don’t have the right processes or tools in place, collecting online reviews can be difficult. In the past, the process was long and cumbersome, so many customers didn’t follow through with leaving a review even though they were willing to do so.

The key for a successful online review program is to make it as easy as possible. You can do this by focusing on which review sites customers already use and then delivering invites via your customers’ preferred communications channel. Doing those two things should result in a significant uptick in your invitation conversions.

Take a look at the Podium offer for Medical Spa MD Members to see how this should be working for your clinic. 

Note: There are a number of other competitor systems other than Podium that you might want to review, but Podium is the only one that is currently a Medical Spa MD Select Partner.

New Research Areas Around Minimizing Scars For Cosmetic Surgeries?


New technologies are promising to be able to reduce the most visible after-effects of surgical cosmetic procedures, scarring.

The ability to truly reduce or eliminate scarring after surgery would be a godsend for surgical procedures where scars are visible. The scars are always a negative for the patient and they can become a focus that lessens the results that the surgery actually delivered. The current crop of lotions and potions have some effect, but some form of aggressive wound healing that minimized or eliminated scars would be an optimal outcome for any procedure.

In the article by published last year in the Science magazine, a research team found that they were able to reprogram fat from myofibroblasts by signaling it with the Bone Morphogenic Protein (BMP), which promote growth. In their study, they were able to find a way in regenerating fat from myofibroblasts in adults. The researchers observed that growth of hair follicles was indicative of adipocyte regeneration, which is what most of their findings resulted.  They noticed that adipocytes grew around the area where hair follicles appeared. 

If it were easy to execute, it could definitely change how aesthetic surgeons can treat scarring in patients.

There is an abundance of research on wound healing in the plastic surgery field. Possibly getting some insight from Plikus et al.’s research, aesthetic physicians and surgeons can be guided into finding a way to signal the BMP receptor, they can benefit greatly in using the approach so they could minimize the risk of acquiring a scar after the surgery and turn it into fat instead. In this manner, the adipocytes might be easier to treat as compared to the scars.

Plastic surgeons employ different techniques to minimize the scarring on the areas in which the incision was made. Silicone sheeting is one of the most popular techniques in minimizing scarring in the area. Another technique is to use corticosteroids (Janis and Harrison, 2014).

There have been many cases that examined treating wounds through methods such as laser resurfacing and injections. These two alternatives do help in accelerating wound healing, with botulinum toxins even enhancing the appearance of scars. Dermal fillers also have been seen to have regenerative properties, which could help in the process of healing.

As of the moment, the research team responsible for converting myofibroblasts to fat cells have yet to test their findings out on humans, but they were able to relate it to what they saw on the mice. It would definitely be groundbreaking especially in the field of aesthetic medicine. For now, it is up to the aesthetic physician to educate the patient how to treat their scars.



ExpedMed National Conference in Little Rock, AK, March 9-10, 2018

ExpedMed National Conference in Little Rock, AK, March 9-10, 2018


Attending an ExpedMed event is a refreshing alternative to the typical CME course. Our ExpedMed CME curriculum is based on the textbook entitled Expedition and Wilderness Medicine edited by Drs. Gregory Bledsoe, Michael Manyak, and David Townes. Drawing from a wide range of wilderness medicine and expedition medicine topics — with a particular emphasis on wilderness, tropical, and travel medicine — an ExpedMed CME course will provide you with the information you need on a variety of important topics, all in a concise and practical format.

Past faculty at our ExpedMed events include Dr. Luanne Freer, Dr. Michael VanRooyen, Dr. Tim Erickson, Dr. David Warrell, Dr. Howard Donner, Dr. Alan Magill, Dr. Rich Williams, Dr. Ken Kamler, Dr. Martin Nweeia, Dr. David Townes, Dr. Michael Callahan, Dr. Karen VanHoesen, Dr. Howard Backer, and many others.

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Vibration Anesthesia + Insulin Syringes: Does it make a difference?

Vibration Anesthesia 

Having some yahoo stick needles in your lips hurts. We try to mitigate that using everything from topical anesthetics (the most common), ice, and even nerve blocks, but should we be using vibration anesthesia and/or insulin syringes?

Vibration Anesthesia has been explored since 2004, but it hasn't reached mainstream adoption.

The study also applied topical anesthetic cream to lessen the incidence of pain as well.


  • 25 patients underwent the procedure
  • 92% of patients were comfortable with vibration anesthesia
  • The 8% of unsatisfied patients felt more pain and anxiety from the vibrations

Previous studies are also on the positive side of vibration anesthesia.

In conclusion, vibration anesthesia is deemed effective from some other studies. Smith et al. (2004) conducted one of the earlier studies of vibration anesthesia with regard to dermal fillers. The researchers recommended the use of vibration anesthesia for several procedures to help alleviate pain, but it is also suggested to use other methods in producing less pain to the patient.

Another study also explored vibration anesthesia, Mally et al. (2014) showed the efficacy of vibration anesthesia, with around 95% of their participants preferring vibration anesthesia.

What anesthesia works in your practice and for your patients?

In another article, an insulin syringe was used to inject dermal filler on the lips. More and more studies emerge in terms of injection techniques. What about what the needles used for injecting dermal fillers, do they matter as well? 

It is best to consider the consistency of the filler (Urdiales-Gálvez et al., 2017) before going through what needle or cannula to use. Many physicians made the switch from needles to cannulas, simply because of its ability to reduce pain and cause less discomfort to the patient. There is collagen stimulation when a cannula is administered (Brackenbury, 2015). On the other hand, needles are more precise, and a few injection sites would suffice. Bruising is the most common complaint when using needles.
Both modes have their pros and cons, but eventually the physician will need to discern, which is much better for dermal fillers.

In one journal article, the researchers found that an insulin syringe is also an effective way to deliver dermal filler injections. Kechichian et al. (2017) used an insulin syringe for lip augmentation. It is a novel method, but the idea is to give the patient more comfort as the injection is administered. Their findings leaned towards the preference of using insulin syringe due to its fine needle.

In the end, it all boils down to the administering of the injection and the comfort of the patient, and the experience of the provider.

Would patches really replace injectables and laser or light based devices?


Microneedle patches seem to have beneficial implications based on the current studies presented by researchers. It could then give another alternative for patients, for those who would need short term solutions or quick fixes maybe. Since the patches were made for the studies, it may be too early to say if it would be produced for the public. 

A few months ago, a microneedling patch to reduce fat was tested on mice, having good effects after the application of patches. In another study, a patch was also developed to brighten the skin, additionally there was another study which examined the use of hyaluronic acid on the microneedle patch. In this new study, a microneedle patch was used to reduce the appearance of wrinkles.

The question then is, would patches be the future of cosmetic medicine?

The latest study in microneedle patches was conducted by Hong and colleagues. The researchers divided the 84 participants into groups of 3, group 1 had the patch applied solely, group 2 had the wrinkle cream and patch, while group 3 had the wrinkle cream only.


  • The researchers examined skin conditions before patch application, and 4, 8, and 12 weeks after application, with group 2 having improvement by 8 weeks, whereas groups 1 and 3 had eventual improve by the 12th week.
  • There were no adverse effects reported in the study.
  • Microneedle patch coupled with wrinkled cream was more effective as standalone patch or cream.

Would these patches have better efficacy than the current treatment options?

Based on the studies presented by the researchers, it would be good to examine the long term effects of using the patch. In the current studies about microneedling patches, there are no signs of adverse effects or symptoms on the subjects. It may be difficult to say regarding the use of patches as the literature is scant regarding it as these are nascent in the field. It does have its benefits, but a long term solution and efficacy are of utmost importance regarding treatments. So far, patches do offer short term solutions according to the studies.

Many things remain unclear regarding the use of patches, such as the long-term efficacy rate, number of treatments done to alleviate wrinkles or brighten skin, but the future of cosmetic medicine holds many possibilities, and patches could help advance the field for many providers and patients to come, considering it holds promise in the field to understand medical aesthetic in microneedling.

Botulinum Toxin as a Scar Treatment

A recent study shows that immediate post-surgery Botox injection could create a better scar appearance as opposed to delaying the Botox injection days after (Hu et al., 2018). The participating authors used saline to treat the other side of the scar side of the scar. Nineteen scars were evaluated in the study, and the authors used the Vancouver scar scale and the visual analogue scale.

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Aesthetic & Medspa Predictions for 2018

If you're ever looking at trends you'll find that there are always the same old things that are trotted out year after year; men are getting more treatments, some kind of new lip augmentation, and a new suture or thread built into a facelift. 

In 2017, the predictions dealt more with dermal fillers and fat transfer. For 2018, according to different aesthetic medicine institutions, the three procedures seeing a rise are Platelet Rich Plasma Injections, Genital Surgery/Rejuvenation, and Periorbital Rejuvenation.

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Botulinum Toxin is Effective in Treating Facial Synkinesis

Two new studies from the JAMA Plastic Surgery studied neuromodulators in treating facial synkinesis, With one of them comparing incobotulinumtoxinA (Xeomin), abobotulinumtoxinA (Dysport), and onabotulinumtoxinA (Botox) among one another (Thomas et al., 2017).

To determine its efficacy, the researchers depended on the Synkinesis Assessment Questionnaire (SAQ).

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Neuromodulators Introduced in 2017

Neuromodulators or botulinum toxins continue to gain popularity considering its effects on patients. Botox remains one of the most trusted brands in the market, and it does not seem to slow down along with the other two brands, Xeomin and Dysport. Of course, not everyone approves of having the botulinum toxins injected on them because of the effects that it has brought.

Revance Aesthetics is currently testing its RT002, and has had studies published regarding the efficacy of their neuromodulator, meanwhile EB-001 is fairly new but according to the company, their botulinum toxin seems to take effect much quicker than the current ones in the market. In that light, will the big neuromodulators brands be replaced by those still in testing phase?

In a previous article we published, we also wrote about Nabota, which has already been in use by some countries. Revance’s RT002 and Bonti’s EB-001 are currently undergoing trials, but both show potential.

According to Bonti, around 32% of patients show interest in having EB-001 injected on them. In a press release, the company mentioned they have conducted a clinical study, and it supports their claims about the product’s safety and efficacy. The product aims to be an introductory neuromodulator for those who have not tried and for time sensitive events.

As of December 2017, RT002 has reached Phase 3, which is showing better results than Botox. According to press releases, RT002 will have a six month duration period. If approved by the FDA, it’s the only neuromodulator that could ever receive that approval. Like the other neuromodulators, it has adverse effects like ptosis and headaches. Phase 3 will end its testing by February 2018.

These new brands will definitely shake the aesthetic market, since providers will have different options to choose. However, would these brands be able to replace the current ones?

These products will continue to compete regarding which one botulinum toxin would be enough to treat glabellar lines and crow’s feet, it is still unknown which among these treat these concern areas better. It is highly unlikely that the current three neuromodulators will be replaced, but possibly their market might change as there are other patients. Currently, patients can enjoy the present neuromodulators provided in your medical spa or practice.