Vice President and Clinical Director of the Colorado Skin & Vein Center, RN Laura Carlsen proves to be an all-around cosmetic provider.
Colorado Skin & Vein Center provides a wide range of services from clinical dermatology (provided by a physician) to cosmetic care (provided by an RN), a common strategy. In this interview Laura Carlsen RN discusses her work and path to a successful career and business.
Name: Laura Carlsen, RN
Clinic: Colorado Skin and Vein Center
Location: Englewood, CO
I graduated from Northern Illinois University in 1989 with a marketing degree. After graduation, I sold IBM electric typewriters, computer maintenance contracts and Aveda skin care. In 1990, I started a home-based business performing facials, microdermabrasion and waxing treatments. I ran that business for 13 years, before graduating from the University of Colorado Denver with a nursing degree in 2009. As a Registered Nurse, I went to work for Colorado Skin & Vein (which was previously known as Colorado Center for Photomedicine) where I have proudly worked for eight years.
What sparked your interest in cosmetic medicine?
When I went to school to become an RN, it was with the intention to stay in the cosmetic industry. I loved doing facials and skincare but wanted to expand on that knowledge. I was doing a lot of acne facials and had several patients ask me about blue light. I knew then that I had to know more about what was available and how I could be involved.
What can you tell us about the clinic?
For eight out of the 11 years that Colorado Skin & Vein has been in practice, we operated with one doctor, one nurse (myself), and one to two support staff. Sometimes we had an esthetician, yet oftentimes we did not. We went from a 2500 square feet space in Highlands Ranch to our current building at I-25 and County Line with over 20,000 square feet. We occupy the top floor and rent out the bottom floor. Our staff has grown to 10 full-time and a few part-time employees. We have three main areas of focus: Dr. David Verebelyi, who does vascular treatments (leg veins, facial veins, port wine stains, etc.), Smartlipo and CO2 resurfacing.
Dr. Kimberly Neyman is our dermatologist and dermatopathologist, and I am the clinical nurse manager who oversees all the aesthetic treatments in our office. The areas that I manage include: Botox, filler, Kybella, cosmetic sclerotherapy, tattoo removal, hair removal, Genesis, IPL, PDL, CO2 for stretch marks, and chemical peels. Our patient population is diverse due to the multitude of services we provide. The cosmetic side is dominated by females in the 30-60-year range, but veins and dermatology attract a more equally mixed ratio of male to female clientele.
As a hiring manager, how do you manage staff?
I am personally involved in most of the hiring. The one thing we found that has worked very well in our favor is doing working interviews. We begin by doing phone interviews, progress to face-to-face interviews and then take our top 2-3 candidates and have them spend a day with us. This allows us to see how they interact with our clients and staff, to see what type of questions they ask and to see if they offer any insight into our current way of doing things. This has dramatically changed who we extend offers to and the culture of our practice. We currently have a staff that we truly love and that are passionate about being here.
The cosmetic providers receive compensation in the form of a base salary and commission based on profit. We used to do it based on revenue, but found that it made sense to the office and provider to focus on profit. When the business makes money, the provider makes money. The front office staff also receives a base or hourly wage, plus commission. Each employee’s commission may be based on increasing production totals, or collection levels, and each year we review their commission structure and decide what to focus on for the coming year.
Which technologies do you usually use in the clinic?
We have a lot of technology in our office which includes: Cellfina, Ulthera, Smartlipo, and CoolSculpting. We use the Lumenis FX for our CO2 procedures and for IPL, Nd:Yag and Genesis, we use the Cutera Xeo. For laser hair removal, we use the Cynosure Apogee Elite and the Lumenis LightSheer Duet and we can treat all skin types. The Lumenis Fotona is used to perform tattoo removal and for superficial vessels, we use the Candela Pulsed Dye Laser.
We are very cautious with how we buy equipment. Years ago, you would buy a machine and own the right to use it. Today, companies like Ulthera and CoolSculpting require disposables or cards to operate. When CoolSculpting came out with the Cool Mini, we had to evaluate whether the $10,000 new hand piece would generate enough business to justify its cost. Since we offer multiple modalities, we had to ask ourselves “could we treat those same areas with Kybella or liposuction” and “could we offer better results than the Mini?”
We never want to be put in a position that we must sell something because we are trying to recoup our investment. We currently do not have the Mini hand piece, but we will constantly revisit this decision as demand grows.
What ways do you get the word out for new patients?
Converting a new patient is always more expensive and time consuming than obtaining more business from a current patient. We try to focus on what our patients want and what they are asking for and we enjoy offering two annual parties per year. One focuses more specifically on new equipment or offerings, while the other is more of a patient appreciation party. Our patients look forward to these parties and enjoy the education, specials and goody bags they receive at them.
As for advertising, we often test the waters. We will try an avenue such as print media and track how many calls came based off the ad. If we don’t see our money back, we don’t continue our business with them. Over the years, we have tried billboards, radio advertising, local print media and community events. While advertising a procedure, like CoolSculpting, can generate some interest, we found that when other practices advertise, it helps drive business to our practice also. Often patients will hear about a procedure they are interested in and then Google to see who offers it at the most convenient location.
Which equipment do you think would be helpful in the practice?
We are currently excited about Cellfina and are planning to see a good return on investment. The research is very good and the patient satisfaction is very high, even after 4 years. We also do very well with CoolSculpting and sclerotherapy. We used to offer facials and microdermabrasion treatments, however, we have dropped those offerings as the profit margin was low. We are considering adding miraDry to our practice.
Can you tell us about any encounters in your eight years of working in the clinic?
I always try to meet or exceed expectations, and I often turn patients away if I don’t feel we are a good fit for each other. Even with that said, you cannot hit a homerun 100% of the time. For instance, I just finished a follow-up appointment with a patient who had recently visited a plastic surgeon for a facelift, but ultimately decided she did not want to have surgery. She wants lift in the cheek area but is cautious. We did Botox and one vial of Juvederm UltraPlus split between both cheeks. Normally, I would have done Voluma, but the patient wanted a natural lift that would perk her up a little and money was tight. I was concerned that doing such a small amount of filler would leave her unhappy as it would not be enough product to lift her cheeks significantly, yet she assured me she would be happy with trying anything.
Now, two weeks later, patient feels she is too full in the cheek area. The photos are beautiful. One half vial of Juvederm in the cheek of a 54-year old woman cannot possibly be too much filler. At the end of the follow-up she asked me to do filler on her jawline, but also stated that she didn’t want it to look any fuller. I told her I could not meet that expectation. I had her take a picture of her before and after on her phone so she can remember what the service did for her and perhaps also get advice from family and friends. As hard as I tried with conversation and showing before and after photos, somewhere the communication was not clear enough that filler will provide a more volumized look. It reminds me to keep attempting to be as clear as possible.
What advice can you impart to physicians or to any provider that is in the aesthetic business?
The best advice I could give is to take great before and after photos and to listen intently to what the patient wants. In the above story, if I had not taken photos, I may have believed that I made the client look worse than before they came in.
About Laura Carlsen, RN
Armed with a Nursing degree and a certificate of Registered Nurse, Laura went to work for Dr. Verebelyi in 2009. Laura has been able to contribute to Colorado Skin and Vein by writing protocol and assisting in surgery, learning laser safety and parameters, taking over the injectable practice, training and overseeing estheticians, and being responsible for all clinic supplies. The number of Botox patients has tripled in the last few years and her filler numbers put her practice in the top 6% in the nation.
Laura’s passion is in helping people to look younger and better, but not “done”. She prefers a conservative, natural approach. Because of her dedication to the long-term care of her patient’s skin, she still retains many of her original clientele from Secret World Day Spa. If you have an interest in perking up your looks but are not sure what to do, meet with Laura for a complimentary consultation. Her expert eye combined with incredible training from some of the top injectors in the world, will have you smiling in no time.