Medical Spa MD Certified Partners

Buy your next cosmetic laser or IPL from a Medical Spa MD Certified Partner with confidence that they will meet our 7 point guarantee.

When you buy your next laser or IPL from a Medical Spa MD Certified Partner, you know that you're dealing with an organization who has agreed to meet our high standards, and that their continued inclusion in our program relies on treating Members with transparency and honesty. All Medical Spa MD Certified Partners have agreed to our 7 point guarantee.

As a Member, If you purchase from a Medical Spa MD Certified Partner who does not meet our standards and our 7 Point Member Guarantee, you can contact us directly and we will intercede on your behalf. If we determine that a Member has been treated unfairly or that there has been a violation of our values, we will revoke that companies privileges and access to the program, and we will list publicly list that company as a business that we will no longer work with. 

If you are a Medical Spa MD Member who have purchased from a Certified Partner and want us to investigate an issue or complaint on your behalf, you may contact us here.

Our 7 Point Member Guarantee

Every Medical Spa MD Certified Partner has agreeded to:

1. Follow our Terms & Conditions and our Code Of Ethics
   You can read them here.
2. Transparent Listing Prices
   Any product listed on our site will be immediatly available at that price. There will never be any "bait and switch" tactics of listing of products that are not under the direct control of the listing company.
3. Lowest Price
   Certified Businesses agree that the price you see on Medical Spa MD is the lowest price for that item on their own site or anywhere else.
4. Awesome Service
   Certified Businesses agree that they will provide Medical Spa MD Members with their highest level of service at all times.
5. Public Reviews
   Certified Businesses agree that after every purchase they will use a verified Podium account to send you a request for a public review of their service.
6. Member Only Benefits
   

   Certified Partners agree to provide free, special benefits, upgrades, price reductions, and/or perks to every identified Medical Spa MD Member purchasing a laser or service.

   You must identify yourself as a Medical Spa MD Member before purchasing to recieve these benefits.

While this program can't guarantee that nothing bad will ever happen, it does go a long way to cleaning up the industry and gives you (if you're a current Member) much more serious remedies and security when you're buying a used laser or IPL. It also begins to clean up the marketplace since we will actively be looking to publicize and identify cosmetic laser resellers who are not ethical or have unhappy customers.

Here's a short FAQ about this new program for Members.

Which used laser companies are currently Certified Partners?

There are currently two used laser resellers in the program; Sentient Lasers and Rock Bottom Lasers. 

• Sentient Laser - Free upgrade from 30 day Silver to 90 day Gold warranty for Members.
  View Member offer from Sentient Lasers 
   
• Rock Bottom Laser - Free upgrade from 60  to 120 day warranty for Members
  View Member offer from Rock Bottom Lasers

Want to become a Certified Partner? Apply here: https://medicalspamd.com/partner

Why is this program needed?

If you've purchased a used aesthetic laser or IPL from an unethical reseller you already know why this is needed. If you haven't had a bad experience yet, we're here to make sure you don't. This program looks to hold laser sellers more accountable since we will actively be looking to publicize and identify cosmetic laser resellers who do not act ethically including.

We aim to make every purchase transparent and ethical for our Members.

Why do laser sellers want to be a Certified Partner?

They want the increased sales from our Members, and they're also concerned about the damage that unethical vendors do to their own reputations and the entire industry.

What types of businesses can be a Certified Partner?

Any business that sells cosmetic lasers, IPLs and medical devices to our target market - physicians practicing nonsurgical cosmetic medicine worldwide - can apply to be come a Certified Partner if they agree to abide by our terms, our 7 point guarantee, and what special benefits they will provide to Members. Applicants are then vetted by us to determine if they should be added as a Certified Partner and can display the Medical Spa MD Certified Partner Seal.

We will only work with vendors who have both the intent and the resources to provide high quality services to our Members. We're currently focused on the used aesthetic laser market but if this program is successful, we may extend it to other areas.

Note: Other businesses may apply to be a Select Partner but only cosmetic laser and IPL vendors may be "Certified" and list their inventory on our site. 

What should I do if I feel like a Certified Partner is treating me unfairly or violating the Certified Guarantee?

First, contact the vendor about the issue. All of our Select Partners are very aware of identifying Medical Spa MD Members and will usually bend over backwards to try and remedy the situation.

If you're still not satisfied, you can contact us directly using the form at the top of this page. We will collect your information and contact the vendor directly to investigate what happened. You may be contacted for additional information. If we determine that the vendor has acted dishonestly, unethically, or violated our Certified Partner Agreement we will take any number of actions up to and including publicly disclosing the issue and banning the vendor from the program and site.

What happens after I file an issue?

The first thing we'll do is collect some additional information from you by email or phone to try and determine the order of events and what happened. You may be asked to forward emails or detail phone conversations. We will then contact the Certified Partner on your behalf to tell them that we're involved and to get their side of the story. (Note: They should already be aware of the issue since you should have contacted them first.)

We will essentially conduct our own investigation to determine if there was a violation of our terms or 7 point guarantee, or if the vendor acted unethically. If we determine that the vendor is at fault we will work with all parties to attempt to resolve the issue to the Members satisfaction.

If we determine that the vendor acted intentionally to violate their agreement with us as a Certified Partner we will take additional actions that may include publicly disclosing the issue or incident, notifying our Members, and removing the vendor from our Certified Program. 

Do you guarantee that I'll be happy with the outcome?

No. You may be a jerk who will never be happy. However, if you're somewhat reasonable we will work hard to come to the best resolution we can for you.

Not a Member yet? You must be a Member to realize these benefits.

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?

---

Picosecond Lasers – Do I need one, and which one to buy?

Guest post by Dr. Steven Ang

This article is a personal review of some of the Picosecond lasers currently available in the market. The relevant distributors in Singapore had provided information on these lasers, when the machines were tested in November and December 2016.

The first commercially available Picosecond laser was the Picosure, introduced by Cynosure Inc about four years ago. Since then, more of such lasers have entered the market. When launched, the Picosure was a 755 nm Alexandrite laser, but Cynosure has since taken measures to introduce two other wavelengths, 1064 nm and 532 nm. All the other companies primarily used the 1064 nm and 532 nm wavelengths, in addition to other wavelengths. These wavelengths are usually introduced to tackle the problem of removing stubborn green and blue inks in tattoos.

For anyone contemplating to purchase a Picosecond laser, the first question that naturally comes to mind is: Is there a need? Is the Picosecond laser really superior to the more commonly available and much less expensive Nanosecond Laser?

According to a systematic review article in the journal, Lasers in Medical Science, in September 2016, the Picosecond laser had not proven its superiority over the Nanosecond laser in the removal of blue and black tattoos. However, in the same journal in February 2017, Forbat, Ali and Al-Niaimi posited in a letter that the applications of the Picosecond laser could extend beyond tattoos to pigmentation reduction and tissue remodeling.

On deeper analysis, the Picosecond technology is rather persuasive. The idea seems logical that when the pulse width is narrowed, laser energy can be more efficiently converted into the mechanical stress needed to fracture particles into smaller fragments, which are easier for the body to remove, and there is less risk for side effects. When used in the removal of tattoos, for example, the notion that the laser exerts a photoaccoustic effect and not a photothermal effect, appears reasonable. Therefore, this can shorten the number of treatments needed.

In evaluating which laser to purchase, I believe you need to consider the following factors:

Is it effective? For this, you can look for published studies and also news about the lasers. One limiting factor is that since Picosecond lasers are relatively new, there may a paucity of studies, and even if available, the sample size is usually small. You should try out each laser for yourself to determine the relative efficacy.

What are the technical specifications? 1000 picoseconds equal 1 nanosecond. To me, in a simplistic way, the lower the wavelength is in picoseconds, the more potential it has. If a greater range of power and fluence is available, the more flexible it is. It is arguable whether you still need a Nanosecond mode, but it is always reassuring if the mode is present.

What is your primary reason to purchase the equipment? I believe that in Western countries, the primary reason is to remove tattoos. In Asia, the main reason may be to treat hyperpigmentation like melasma.

What is your budget? The Picosecond laser doesn’t come cheap and you need to set aside a budget of about USD$200,000 or more. You need to plan carefully to optimize your return of investment.

Are there any local factors that may influence your purchase? For example, the strength of representation of the distributor/agent in your state/country is important. The major manufacturers usually have their appointees in each state/country. The track record of the distributor/agent in servicing and repairing machines is important. Another local factor to consider is whether the machine can be used on your local electricity grid or whether you need to make special adaptation.

Should you buy a new machine or a used one? Because of the short history of the Picosecond lasers, there may not be many used units in the market. Check the usage clocked, the ease to service the machine and the potential costs to service and if need be, repair the equipment.

I have reviewed the following Picosecond lasers: The Discovery Plus from Quanta, the Pico Plus from Lutronic, the Picoway from Syneron-Candela and the Enlighten from Cutera.

A comparison is given at Table 1.

Name of Laser

	Discovery Pico Plus	Pico Plus	Picoway	Enlighten
Manufacturer		Quanta System S.p.A	Lutronic Corporation	Syneron-Candela	Cutera
Wavelength 1		Nd: YAG 1064 nm	Nd:YAG 1064 nm	Nd:YAG 1064 nm	Nd:YAG 1064 nm
	PICO, pulse duration Maximum energy	450 ps 800 mJ	750 ps 600 mJ	450 ps 400 mJ	750 ps 600 mJ
	Q-switched, pulse duration Maximum energy	6ns 800 mJ	2ns 800 mJ	Not applicable	2 ns 600 mJ
	Opti-pulse, pulse duration Maximum energy	6ns + 6ns 1.2 J	Not applicable	Not applicable	Not applicable
	Photo-thermal, pulse duration Maximum energy	300 ms 2 J		Not applicable	Not applicable
Wavelength 2		FD Nd:YAG 532 nm	FD Nd:YAG 532 nm	FD Nd:YAG 532 nm	FD Nd:YAG 532 nm
	PICO, pulse duration Maximum energy	370 ps 300 mJ	Available	375 ps 200mJ	750 ps 300 mJ
	Q-switched, pulse duration Maximum energy	6 ns 400mJ	Available	Not applicable	2 ns 300 mJ
Wavelength 3		Ruby 694 nm, QS, 30 ns, 1200 mJ	595 nm Gold Toning	785 nm	Not applicable. In the process of introducing 670 nm
	PICO, pulse duration Maximum energy	Not applicable		Will be in picoseconds, not available in Singapore yet
	Q-switched, pulse duration Maximum energy	30 NS 1200 mJ		Not applicable	Not applicable
	Photo-thermal, pulse duration Maximum energy	2 ms 2J		Not applicable	Not applicable
Wavelength 4		Not applicable	660 nm RuVY Touch	Not applicable	Not applicable
Fractional laser or equivalent		Yes, 8 mm fractional round hand piece	Yes, Focused Dots 1064 nm	Yes, Resolve hand pieces	Yes, Micro Lens Array Fractionated System
Price		++++	+++	+++++	++++
Strengths		Versatile. High energy.	Many types of hand pieces with different wavelengths.	Easy to use and ergonomic. Size fits in any office.	Known for PICO Genesis in skin toning.

In conclusion, whichever machine you purchase, there is bound to be some element of regret as each machine has its relative strengths and weaknesses. It is only human to always think that the grass is greener on the other side. Just make a decision and move on.

Have something to say? Write a guest post on Medical Spa MD.

The New Medical Spa MD Guide To Aesthetic Laser Platforms Is Out!

The Comparative Guide to Aesthetic Laser Platforms is now available for free to all Medical Spa MD Members.

Choosing which aesthetic platform you're going to build your clinic or medical spa around is one of the most important, and expensive, decisions that you're going to make. Switching costs are high and if you make a mistake, you're going to be regretting it for a long, long time.

Included Laser Platforms:

• Alma Harmony
• Palomar Icon
• Syneron elos Plus
• Cutera Xeo
• Sciton Joule
• Syneron Emax

This first edition guide offers a starting point for physicians and clinics who are just beginning to research the purchase of a platform, or as a resource for dotors who are in the market but want to know what else might be available. We've done much of the preliminary leg work for you by taking six popular platfroms from Palomar, Sciton, Alma, Cutera and Syneron and comparing them across a number of treatment modalities.

We've also included links throughout the guide to the discussion forums on each platform for deeper investigation that allows you to ask questions directly from other physicians who own that specific laser, as well as discuss other important purchasing decisions around consumables (which can be a significant cost) and support (which can be critical).

Download this free aesthetic lasers report >

Medical Spa MD Guide to Aesthetic Laser Platforms

Note: While there are dozens of laser and IPL systems that might have been included, we started with thise six since they're all "multi-purpose" platforms with wide utility, widely available around the world, and are generally well known. If you represent a cosmetic laser company and would like to be included in future reports, please contact us.

Do you have a suggestion to improve our services or an idea for as research project you think we should be doing? Would you like to be interviewed, or sponsor a report? Please contact us.

Our contributing physician list is growing fast. Thank you to the physicians and clinics who have contributed to this report.

Also: Please feel free to distribute, email, link to, tweet, post or send this report to anyone who may be interested as long as you do not modify or change the report in any way.

Palomar Icon Aesthetic System

Some information about the Palomar Icon system from the upcoming Comparative Report for Aesthetic Laser Platforms.

We're writing a new report for Members that compares the most used aesthetic laser platforms. One of the most popular platforms, at least in the US, is the Palomar Icon.

There are always discussions around the Palomar Icon and other cosmetic lasers in the forums.

About The Palomar Icon Aesthetic System

The Palomar Icon Aesthetic System builds on Palomar’s 20 year history of creating quality aesthetic technology.  The platform itself is powerful and compact, offering a max power of 1600 VA.  Offering nine applicators, this system is modular and able to perform common treatments such as hair removal, leg vein treatment, wrinkle treatment, and fractional ablative and non-ablative skin resurfacing.  Unfortunately there is no application for lipolysis available.  The us

er interface screen is relatively small but includes treatment tracking software to improve feedback during treatment.

The Palomar System includes the only FDA- cleared melanin reader available.  Known as Skintel, this reader allows quantitative determination of the average melanin density of the skin prior to treatment.  The system also takes advantage of increased surface coverage over its competitors allowing for greater overall effective energy and faster treatment time.   The Palomar system can complete a full face single pass high speed non-ablative fractional resurfacing in less than fifteen minutes.

Overall patient comfort is optimized by adjustable cooling technology.  By maintaining a treatment temperature of five degrees Celsius skin damage is minimized and your patient is more comfortable.  In addition, dual filters minimize excess epidermal exposure and further enhance patient comfort.

Used Palomar Icon Systems are available online, however quantities are limited.  Pricing varies depending upon the age and configuration of the machine.  

Sciton Loves The Medical Spa MD Physician Report

It appears that Sciton is happy where they ranked in the first Medical Spa MD Physician Report

Download the Medical Spa MD Physicians Report #1 here.

I received a copy of a press release that Sciton sent out a few days ago that details their placement in the report. Here's the release:

Physicians Rank Scition #1 In Cosmetic Lasers

PALO ALTO, Calif., November 18, 2011 – Sciton, Inc. was ranked First in Class among aesthetic laser manufacturers in a survey of Medical Spa MD’s 5000-member physician community of plastic surgeons, cosmetic dermatologists, medical spas, and laser clinics.

In its first “Physician Report” (http://medicalspamd.com), Medical Spa MD asked physicians which technology they would recommend and respondents overwhelmingly selected Sciton, ranking it highest among the 16 manufacturers represented in the report. Physicians also identified five Sciton systems as their top choice for aesthetic medical applications in their clinics, including the JOULE, SkinTyte, ProFractional-XC, BBL, and Profile, in a demonstration of “remarkable brand loyalty,” and awareness. The Sciton systems identified are used for skin resurfacing, skin firming and tightening, laser hair removal, treatment of vascular and other skin conditions, body shaping, among other procedures.

Sciton is the leading manufacturer of high quality, modular, multi-application medical laser and light systems for the aesthetic market that can be tailored to a practice’s specific requirements. Additional confirmation of the quality, reliability and robustness of these laser- and light-based devices lies in the fact that over 95% of all the lasers ever manufactured by Sciton during its 14 year history are still in use. Dan Negus, President of Sciton, commented, “While we take great pride and care to design and manufacture outstanding and long lasting laser devices, it is extremely gratifying to see this recognition of our products’ quality and value by the clinicians in the Med Spa MD survey. We are elated that such a prestigious group of physicians has validated Sciton’s longstanding commitment to the quality and utility of its products.”

Medical Spa MD operates a premier online resource for providers of cosmetic medicine. This is the first year the organization has published its Physician Report, highlighting Sciton as the most utilized and recommended laser device manufacturer.

The survey also showed that treatments and applications made possible by the company’s technology are among the most profitable that cosmetic physicians offer, a circumstance promoted by Sciton’s commitment to well-built, high-quality products that pay for themselves over time without requiring an ongoing investment in consumables.

Now, the press release is carefully worded but I can't fault Sciton for putting their best face on with this. For example, the last paragraph says that, "treatments and applications made possible by the company’s technology are among the most profitable that cosmetic physicians offer", but those are the same treatments that are made possible by other techonology companies. Still, it reads well and is factual.

We're working on the next report now and I hope to have it out shortly.

I have no idea where anyone will rank in the new report since the questions are all different.

Medical Spa Classified Ads: Thermage NXT, Cutera Titan...

If you're looking for a used IPL, Thermage NXT or cosmetic laser, check out the cosmetic lasers classified ads section.

Current listings include:

• Thermage NXT
• Cutera Titan Solera
• AeroLase LightPod Laser
• Hoya Medlite c6

If you want to read about or discuss any of these cosmetic lasers you can do so in the Cosmetic Laser & IPL Reviews forum.

Other cosmetic lasers and IPL forums:

• Alma: Accent XL, Harmony XL, Pixel C02
• Candela: Gentlelase, Smoothbeam, Vbeam
• Cutera: Xeo, Solera, CoolGlide
• Cynosure: Elite, Affirm, Cynergy & Smartlipo
• Lumenis: Lightshear, AcuPulse & UltraPulse
• Other IPL & Cosmetic Lasers
• Palomar; Starlux, Slimlipo & SINON
• Sciton: Joule & BBL
• Solta: Thermage & Fraxel
• Syneron: elos, eLight, eMax, LipoLite

Medical Spa MD Podcast: Dr. Thomas Young & Smartlipo

In episode 8 of the Medical Spa MD Podcast, Dr. Thomas Young of Young Medical Spa discusses new Smartlipo techniques and training, choosing cosmetic lasers, and cosmetic stem cell treatments.

We discuss the latest trends and nonsurgical cosmetic technologies including Smartlipo, stem cell treatments, laser liposuction, technology choices and integrating new surgical techniques into your cosmetic practice.

Dr. Young began performing SmartLipo Laser Body Sculpting soon after it's FDA approval and was the first physician to introduce awake tumescent laser liposuction to the Lehigh Valley. He trains other physicians across the country in awake tumescent liposuction and liposculpture procedures and was the first physician to perform Vaser® Lipo, SlimLipo, Body-Jet®, Stem Cell Enriched Fat Transfer Natural Breast Augmentation, Brazilian Butt Lift, ZERONA, VelaShape, and the Soprano XL Pain-free Laser Hair Reduction procedures in the region.

Medicams Reputation: Cosmetic Lasers & IPLs

Medicam is an IPL & cosmetic laser company in Canada that I don't have any first-hand knowlege of since I've never had any experience with them... but someone doesn't like them.

We've always allowed anyone to post their own opinion, but some individuals with a grudge will attempt to abuse that by posting negative (or positive) reviews and comments under different names. 

Here's a number of comments about Medicam and their cosmetic lasers and IPLs:

Dear friend! Whatever you do - do not buy a Medicam Inc. IPL or have any business with this people! You might as well just put money straight to the garbage. Be very aware of [name removed], sales representative. He will lie and cheat, and took advantage of you and your money. He will sell you the machine in Canada - even though it is not FDA approved, and it is illegal to sell it in Canada. He will sell you hand peaces that are dangerous for health. Medicam claims their parts are from Canada. ALL MEDICAM PARTS ARE FROM CHINA. I know to separate independant people who know industry very well, and they are well informed. This people will go some day to jail, because the way they run business in Canada is illegal. I live in Mexico, but I have friends who live in Ontarion, and I hear nothing but the nightmare stories, about this company. If you still want to go ahead, and have business with them, May God help you, my friend.
-JJ

Dealing with Medicam Inc, Montreal based company offers the worst customer service. They talk and promise a lot, but do not deliver. What a waste of money. There are so many great US and Canadian companies, and on average the great IPL machine cost 35 000$. Their machine cost around 40 000$, but they lie by telling you that machine cost close to $60 000, and than they pretend they offer the deal. Somebody wrote above that machines are made in China. Everybody knows that. All the parts are form China, they just put parts together in Canada.
-John

Medicam is a lie! It is a bullshit company! They talk big, but do not believe anything they say. I wanted to see their factory, but they always had excuse.. they never wanted to show me. Why? Because they do not have factory in CAnada!
They do not have licence to sell their machines.
If you are in trouble, they will not take care of you.
All the people that have trouble with Medicam should do something together to shut them down, before they still more money from people.
- Joana

It is poor quality IPL. It will break down, and it is not possible to fix it
- xx

The trouble is, the Medicam rep is right. All of the comments above were posted by the same individual. They're all from the same IP address (96.49.115.160), using the same computer in Vancouver British Columbia.

While I make it a point to try and never stifledissent or real opinion, it's obvious that the comments above are neither. It's greatly irritating when someone uses Medical Spa MD to comment under different names in order to damage an individuals reputation and this makes me pretty damn mad.

While I don't have any real opinion about Medicam one way or the other since I've never owned one of their IPLs or lasers, the fact that the comments above were obviously made with the explicit desire to mislead rather than just post a legitimate gripe anonymously means that the individual wasn't really trying to share any knowledge. For that reason I've modified them.

Oh, and there's this from the Medicam rep named above that was posted as a response and I found quite persuasive.

To everyone concerned,

I was asked to visit this site this morning and must say that I am extremely surprised to find what is mentioned in certain posts.

First of all, MEDICAM is an ACTUAL manufacturer. ANYBODY who wishes to visit our offices and factory are more than welcome and it'll be my personal pleasure to give the tour myself.

Secondly, all posts shown on 09/26 are by the same person. Jake, you do not fool me with the JJ, Joana (your manager) or 'xx'. I frankly find it ridiculous that you would attack me personally. Believe me when I say I sleep on both ears at night, knowing everything than I have done for you. These attacks just show how unappreciative and unreasonable you actually are. One last thing in regards to this, mention or attack me personally one more time and you will be hearing from my lawyer. Your childish games end here. I could simply state point by point how wrong you are and allow everyone to come to their own conclusions, but exposing your dirty laundry isn't something I will do. The only thing you accuse us of that is actually true: the art exposed in our office isn't related to lasers! I hadn't received the memo from the National Art Institute stating that art shown in an office has to represent what is sold within. Completely ridiculous!

Lastly, and more importantly, I appreciate these blogs as they provide potential clients with an unbiased point of view. This being said, certain clients will never be satisfied and we know of certain competitors who lie since they have nothing else to counter our prices and services. All information must be analyzed with this in mind. We have absolutely nothing to hide. The Chinese manufactured, unsafe, no service, certification approvals and other ridiculous comments are all LIES.

Once more, I invite anyone wishing to get clarification to call our offices: 514-737-0404. I'll me more than happy to take the call myself.

Best regards,

[Name Omitted]
Sales Director
MEDICAM INC.

Now Medicam could have been stupid, but they weren't. The individual singled out just posted a comment underneath the others. I'd point out that this is the kind of response that actually protects your reputation and makes you seem reasonable.

It's also a good reminder to take everything you read with a grain of salt.

I'm going to leave the comments up for a short time and then remove them. There are others who want some real cosmetic laser reviews and opinions without the drama.

I just wonder who Jake is.

Cosmetic Lasers, User Groups & Clinical Exchange Forums

Medical Spa MDs forums are getting some TCL.

With tens of thousands of comments, the navigation menu had pretty much outgrown the the previous navigation and was bursting at the seams. The only way to really drill down and find information was to search, and that's somewhat clumsy since you have to know what you're looking for.

We spend the last couple of days and nights attempting to create a better system that allowed physicians to brows by topic as well as have access to holistic search functions. It's still in need of a little tweaking but we're letting you see it now.

Medical Spa MDs new forums are divided into four broad categories:

• Medical spa business

  that includes legal and marketing and advertising forums.

• IPL & cosmetic lasers grouped by manufacturer 

  You'll find a special forum on cosmetic laser & IPL reviews and comparisons as well as forums for Palomar, Cutera, Sciton, Lumenis, Candela, Cynosure, Sineron, Alma, Solta and others. I've also put all of the IPL & cosmetic laser user groups in one place.

• Physician clinical exchange

• Used cometic laser classified listings

These changes to the forums combined with the new area for Medical Spa MD Select Parterns should allow you to navigate the site and find information that's relevant to your needs more easily... at least I hope so.

We'll try to manage the places that posts are found and move them to the appropriate location when we can. Of course there's a huge amount of overlap. I've included pretty much any fat removal treatment under the Bodyscupting & Liposuction forum for example. While it's not perfect, I think it's much better to have only a few forums that you can peruse.

If you haven't used the forums before, please do. We have a very active physician community who are very helpful. Many of the best threads on the site were started with physicians asking very specific questions around treatments, techniques, and other 'down in the trenches' queries.

If you would like to have a forum added or think we've missed something please let us know. If there's enough content or interest we'll add it.

Also, if you're a physician who has some great information or something to say on any topic, please submit it as a guest post and help everyone out.

Zerona Lasers

Thoughts on Zerona Lasers

LH (Dr. Lornell E. Hansen II MD) has this comment on the latest Zerona Lasers review discussion around the effacacy of Zerona for 'fat melting' and a study that was just released.

Here's the Zerona Body Sculpting Study

Low-Level Laser Therapy Effectiveness for Reducing Pain After Breast Augmentation American Journal of Cosmetic Surgery Vol. 26, No. 3, 2009
Robert F. Jackson, MD; Gregory Roche, DO; Todd Mangione, DO

LH's comments:

...I do have to apologize as I did not know that the article had been published. The last I had read was that it was waiting for review. I also want people to understand that I am not saying that the physicians involved in the study did anything wrong with my evaluation of the article. I just think that the company is over marketing the product and charging way too much.

My critique:

1. The first thing they teach you in medical school on how to evaluate research is who paid for the research. In this case the sponsor of the research and article was Erchonia the company that makes Zerona.
2. Who wrote the article? In this case the article appears to have been written by Ryan Maloney. Who is Ryan Maloney? He not only is the medical director of Erchonia he actually has ownership in the patent of the Zerona. Other than that you do not know his background. We know he is not a PhD or physician otherwise it would be behind his name under the authorship of the article. He has a direct financial benefit to write the article in a positive light.
3. 8 Individuals did not have final measurements. The first question is why? 4 were from the treated group and 4 were from the placebo group. At first that seems OK, but when you look further into they kept all of these test subjects included in the study. What they did is they took the last measurements for those subjects and carried them forward. Again seems Ok at first but when you start to look at the trend of circumferential loss at the 2 weeks post treatment the measurements are trending back toward baseline. So if you include these patients last measurement (which by the way is the best overall average circumferential loss during the treatments for the treated group) and carry them forward they will artificially lower the true values two weeks post treatment. All 8 of these subjects should have been eliminated from the study.
4. There is no assessment of cosmetic benefit. To have this be worth something you would need before and after pictures that are reviewed by a group of individuals that are blinded to which treatment the individual participant received. So in other words is a 3 inch loss aesthetically significant.
5. They do not state if participants are male or female. So the question is left, does it work as well on males as it does on females? This could be very important as males tend to have thicker skin so does the laser penetrate as deep in men?
6. the study was limited to patients with a BMI of 25 to 30. Now I think it is fine to have this limitation as you have to start your research somewhere. But the limitation is that the article is implying that it will work for all BMI's. What about the thinner female patient with a BMI of 20 but has a small lower abdominal pooch? Or what about the patient that has a BMI of 35? This should be stated in the conclusion but Mr. Maloney seems to forget this.
7. They also do not state if the patients received their treatments for free or if they were compensated for their time. This is only important for the portion of the study that talked about the patient satisfaction. We need to understand that patients will put a value on the treatment because if something is free their expectations are much lower. their expectations are much higher if they paid $2500 for the treatment. So if this was free to the patient and you have 30% of the treated group that are dissatisfied or neutral what would that mean to a clinic if the patients are paying for it. I would guess you will have a much higher dissatisfied group that either wants their money back or free treatments. I do not want something in my clinic that has a 30% failure rate.
8. They do not discuss if either group was asked to change their diets. This should be stated up front in the methods portion of the article. They also do not mention if there were any dietary supplements required such as niacin. Most clinics using Zerona are having the patients take niacin even Erchonia recommends it.
9. They set the standard for success to be an inch loss of 3 inches or greater. Only 62.86% of the treated group achieved success. So this translates in to a 37.14% failure rate. Again, not something that I would want to stake my reputation on.
10. Now what do the numbers mean? If you look at the numbers the patients baseline combined measurement average was 120.31 inches. At week 2 of treatment (the best measurements achieved) the average was 116.79 inches or an inch loss of 3.52 inches on average. This sounds pretty good until you look at the true numbers. Using the numbers from the study this equates to a 2.9% inch loss as measured over 4 areas. Is this clinically (visually) significant? I do not think that most individuals will be able to see a 2.9% change or if they can it will be meaningful.
11. Lets take a look at the 2 weeks post treatment measurements. Remember, these are not true numbers as 4 patients had their best numbers included in these measurements pulled forward and included here. (I think all of their measurements should have been puled out). At 2 weeks post treatment, you see a 0.31 inch increase from the circumferential measurements at the 2 week treatments. What this equates to is an 8.8% increase in inches in only 2 weeks. So what happens at 4 weeks? 6 Weeks? So if it were a perfectly linear increase it would only take about 20 weeks or so to be 100% back at baseline. That is if it were linear and I highly doubt it is a linear response and if i had to guess most patients will be back at baseline measurements within 6 to 10 weeks and this is why there are no long term studies. The company has had ample time to produce longer term studies they apparently do not want to.

So as you can see, there are a few issues with this article and how it was analyzed and written. The first and foremost problem is that the article was authored by an individual with direct financial interest in the product. The ASLMS journal never should have published this article due to the authors conflict of interest or it should have a disclaimer prior to the abstract. I have no vested interest in any of these non-invasive technologies and would love to see something like this work and have long term benefits for the patients. I think this technology may have better long term benefits on cholesterol etc. I have heard that there are some interesting studies coming. I just hope they are not written by Mr. Maloney. And for others reading this I assume that Chad works for Erchonia or the marketing company that is selling this thing to anyone they can including chiropractors.

Sincerely,
Lornell E. Hansen II, M.D. (LH)
www.LazaDerm.com

p.s. Sorry for being so long winded but I could not help myself. I want these companies to be held to higher standards. I think the ASLMS should have higher standards as well.

If you read the thread there's some interesting thoughts that spring to mind. If Chad is not with Zerona it would be the first time in my experience that a patient has been searching for peer-reviewed medical studies before deciding to have a treatment... I'm just saying.

Of course this qualifies as a guest post and a well deserved back link.

Any other physicians using Zerona have any thoughts?

Cynosure hair removal lasers + service

Buying used cosmetic lasers can be tricky.

For those of you that have had problems with Cynosure there is help, for those that do not or have not had problems you are lucky.  Not all of Cynosure service department is bad, there are a few good technicians and some that are just there for a job. 

Cynosure hair removal lasers are very good if maintained properly.  There are few things that you must be aware of:

1. Flash lamp pulses on the Cynosure: Do not go over 1 million on the yag and 750,000 on the alex.
2. Keep track of your voltage: Do not run the laser over 820v, this could lead to pump chamber failures and blown power supplies.  These will be very expensive repairs.
3. Inspect your hand pieces every time you use them, making sure that there are not large pits and / or burn spots inside.  Keep your windows clean and change frequently.  If your hand piece is getting hot during use, then you have problems with it, and the hand piece needs to be checked.

If you are thinking of having your Cynosure laser service by a third party company, just remember not everyone can work on them, even some of the manufacture’s technician have problems working on them. There are many after market parts available as well but you get what you pay for. Would you take your Mercedes to Bob’s Auto for service?  I know of only a couple technician outside of Cynosure who can repair them.  We make sure that you get what you would expect from the manufacture.   

If you are thinking of purchasing a used Cynosure laser or other cosmetic laser, please have a technician that knows the laser look at it for you before you put any money down.  Would you buy a used car from a fly by night dealer without having your mechanic look at it? I have seen and heard every nightmare you could think of, I have also seen some very good deals.  I had a lady call me that purchased a laser that had blown the power supply on it 2 weeks after purchasing the laser.  That same laser was about to be sold to a customer of mine that wanted me to help him find a laser.  I told him that this laser in poor shape and that it would need very costly repairs.  I was not surprised when the lady called me and gave me the serial number of the laser.  It does not cost to get a second opinion on something that could save you in the long run. 

When it comes to Cynosure, Candela and Deka lasers if you are having problems or need support please feel free to contact us at Integrity Laser Inc.

Note: The above is a guest post from Integrity Laser. If you would like to write for Medical Spa MD please contact Medical Spa MD here.

Fractional Laser Resurfacing Chat

Wednesday March 11, 2009.

9 - 10 PM EST

To join this live fractional laser resurfacing chat, just click this button (at the right time).

Participate in the conversation as Fraxel, Lumenis, MiXto, Juvia, Dot, Lutronic and others (even a PreOwned Laser Dealer) try to convince MAPA Man to purchase their Fractional CO2 Laser. Fractional Erbium and Cutera Pearl Fractional will also be invited.

Wednesday's Chat is going to be about all the Fractional Technology.

• CO2, Glass Erbium, Erbium, Pearl
• How deep, What Percent of Surface Area
• Ablation vs Coagulation
• Dwell Time, Spot Size

We are going to discuss it all! Everyone is Welcome. We will have experts on the Sciton ProFractional, Lumenis UltraPulse, Juvia, Fraxel and others

Discussions include treatment perameters, effectivness, cost, the technolgies and anything else of interest. All interested parties are invited. Reps who identify themselves and are willing to engage in open discusion are also welcome.

To participate: Click the launch window button above at the scheduled time.
Looking forward to seeing you.

Read Previous Chat Transcripts

Sciton BBL IPL Live Chat Scheduled

Next live physician chat has been scheduled for Tuesday, February 24th at 9PM EST. IPLs including the Sciton BBL will be discussed. All interested parties are welcome.

Transcripts of past medical spa physician chats: medical spa marketing & advertising, Thermage, Fraxel, Fractional C02Laser, & Fraxel Technology & Protocols.

Next live physician chat:

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

All IPL users are welcome. Intense Pulse Light (IPL)Chat Tuesday February 24, 2009 9:00 pm - 10:00 pm Eastern Sciton BBL and others. All Welcome.

Physician Training Review: How to inject Juvederm Injectable Gel by Allergan

By CHMD: Just viewed "How to inject Juvederm Injectable Gel" by Allergan 2007.  This instructional video was terrible! 

The technique was poor and anyone who tried to inject after watching this video is sure to get bad results.  Allergen should be embarrassed to put this video out. 

 

This points up two big problems with the injectable industry.

 

First, the instruction from the big companies is terrible, it stinks.  There videos are horrible and their instructional seminars are usually very bad as well.  They only show you one way to do things and you have to know many techniques.  The instructors many times don't know HOW they get the results and cannot explain and demonstrate how.  They use 3-4 syringes when we are only able to use 1 or 2 in clinical practice.

 

This is my recommendation to Allergan, Medicis and the others.  Make a great set of instructional videos which demonstrate and instruct how to do injections well.  Make them easily available to everyone.  Work together and share costs if you want.

 

Second, the FDA does not let the big companies instruct us how to do injections unless it is FDA approved for that area.  Since only the Nasolabial folds are FDA approved, that is the only instruction we get.  Allergan and Medicis TELL us to inject it everywhere, but they don't and can't tell us how to do it and get the best results.

 

My recommendation.  FDA, your rules are hurting, not helping us.  "Unintended Consequences"! Open your eyes and take a look at what is going on and modify your rules.

 

My other recommendation.  Allergan and Medicis, open your eyes and see how many BAD injections are done which turn patients (and their friends and family)off to injectables. Teach us how to do these injections correctly.  Don't just hire a plastic surgeon who does good work (and can't teach), hire someone who can teach.

DeepFx Forum (Exclusively for Encore UltraPulse Users)

Reliant UltraPulse Fractional CO2 Laser

 

DeepFx Webinar:  Notes and Analysis - Tuesday May 19, 2008
Reliant UltraPulse Fractional CO2 Laser

Introduction

Many Laser Companies offer regular Webinars for marketing and education (mostly marketing). These companies include, but are not limited to: Cutera, Lumenis, Reliant and Cynosure. These Webinars are available live or on the companies’ websites in their Webinar Archive Area. 

We have produced these notes for several reasons. We want to generate a clinical discussion of these Webinars so we can all learn more from the Webinars and learn even more from the discussion. We want to clarify certain points that were not clear during the Webinar. We want to ask and answer questions that were not asked and answered during the live Webinar (there is never enough time to ask and answer all questions). It takes 2 hours to sit through a Webinar, most are for marketing purposes and not worth our time, these notes will help us decide which Webinars we want to watch. Hopefully many times we will not have to watch the Marketing Webinar once we have read the summary and participated in the resulting discussion. This will enable us to get the information without sitting at our computer watching a Webinar for 2 hours. 

The bottom line is that we all need to become better providers of services and get better results which generate happy patients who refer friends and family to our practices. By having easier, more convenient access to the information in the Webinars and sharing our thoughts and experiences, we all learn more quickly and we avoid making the same mistakes made by others.  In this manner, we gain access to “best practices” more quickly and the whole field evolves more rapidly. We want to use these Webinars as “Seminal Events” to stimulate meaningful “Clinical Exchange” of important information.

We hope to get the industry “Luminaries” to participate in these discussions. We also hope the Laser Companies will start to host these type of “On-Line” discussions after their Webinars and we hope the Laser Companies will start to host more “Continuing Education” Webinars rather than just “Marketing Webinars”.

The first set of notes is from a Lumenis Webinar about the DeepFx treatment with The UltraPulse Fractionated CO2 Laser. This was a Round Table Discussion with some of the top Cosmetic Physicians in the field. It was very good, but had its flaws and requires further discussion and clarification on points made. The participants (Luminaries) were James Heinrich, MD, Robert Weiss, MD, E. Victor Ross, MD and Jeffrey Dover, MD.

If you are considering using the information in this summary, please view the Webinar to make sure you are comfortable with the parameters! If you view the Webinar and find any inaccuracies in my notes, please correct them in our discussion on MedicalSpaMD. I am hoping Lumenis and “The Luminaries” will review these notes and comment.

 

TotalFX Notes

Basic Facts & Theory:

1. ActiveFx plus DeepFx gives you a TotalFx Treatment
2. ActiveFx ablates 1.3 mm columns and can go 300 microns or 0.3 mm deep
3. DeepFx ablates 0.12 mm columns and can go 2000 microns or 2.0 mm deep
1. 1000 microns = 1.0 mm
4. 125 mj of energy with ActiveFx penetrates 300 microns deep
5. 30 mj of energy with DeepFx penetrates 1.9 mm deep (1900 microns)
6. Most photoaging occurs in the papillary dermis (the worse “solar elastosis” in elderly farmers is at a depth of 800 microns), so there is no need to go deeper.  Therefore our panel recommended a max DeepFx strength of 20 mj (1 mm deep?).  Going deeper gets you more tightening because of more tissue ablation and volume loss.   
7. Using 30 mj of energy and going to 2.0 mm deep has caused scarring around the eyes in one provider’s experience.  They do not recommend going this deep.
8. How long does the tightening last?  No one knows for sure.
9. ActiveFx:  Density 1:  75%; Density 2:  80%;  Density 3:  85%;  Density 4:  95%;  Density 5:  100%
10. MaxFx is ActiveFx at Density 5:  100%.
11. The MaxFx now is somewhat different than CO2 treatments done in the 1990s because only one pass is done.  In the 1990’s 3 passes were done wiping off the epidermis in between passes.
12. DeepFx:  Density 1:  5%;  Density 2:  10%;  Density 3:  15%;  Density 4: 20%;  Density 5: 25%.
13. Stronger treatments are done with the TotalFx on the West Coast.  Why?  In California the people have greater solar damage so you need higher settings OR the people in California are more demanding and want more dramatic results.  Interesting question!  What do you think?
14. Healing is slower off the face.  Dr. Weiss says 2-3 times longer, did he mean 2-3 days longer?
15. Doing Upper Lip Treatments with TotalFx can cause more vermillion lip border to “show”.  This is good

Clinical Tips:

16. Do the DeepFx first and then do the ActiveFx
17. If the DeepFx causes bleeding, wait until the bleeding stops before doing the ActiveFx (blood will absorb the energy from the ActiveFx pulses)
18. The experts said that they did a second treatment one month after first treatment.  I was told to wait 3 months.  This one month interval is new information to me. My big question to Lumenis is “when were you going to tell me and your other users about this change?  How do you keep us up to date about changes like this?”  I am pissed off, I am angry.  I want an answer and I want it NOW!
19. Dr. Ross sometimes uses thrombin spray (from Baxter) to stop the bleeding.
20. With DeepFx, you treat lower face first and move upwards so blood won’t drip down into your treatment field.  “South to North”
21. Do DeepFx before you do fillers.  The DeepFx may go deep enough to disrupt the fillers.
22. You can do fillers and then ActiveFx because ActiveFx only goes 100 - 300 microns deep.  Fillers are placed deeper than this.
23. Anesthesia:  Atavan or Valium (5 mg), IM Torodol 60 mg, Zimmer Cooler, Pliaglis Topical or Topical Lidocaine.  Is po Torodol ok? What about Percocet or Vicodan?
24. You may need to use a nerve block for upper lip treatment.  Dr. Weiss, “Do you do the Infraorbital Nerve Block or 5 short injections near the upper lip gingiva?”
25. Use intraocular eyeshields for upper eyelids.  You might be able to use tongue blade wrapped in moist gauze for lower lids
26. Segmental Resurfacing:  Do IPL on cheeks for pigment and do ActiveFx in peri-occular areas for fine lines and tightening.  Get the most out of your hour with the patient.  This sounds like a great idea-Segmental Resurfacing!
27. Dr. Heinrich does DeepFx only and then Deep plus Active one month later.  He says the patient’s skin gets used to treatment the first time, so downtime is less the second time.  This is my question:  what is the downtime with the first treatment and what is the downtime with the second treatment?  Do patients have to have two 4 day periods of downtime within 30 days?  I am not sure this makes much sense.
28. Some older patients (your mother-in-law) really need traditional CO2 or a facelift.  Give them that option.
29. Class 4 Wrinkles:  The best option is traditional CO2 with two weeks or downtime OR do TotalFx  2-3 times at one month intervals (Dr. Heinrich)

Treating Specific Conditions:

30. DeepFx is best for vertical lip lines, deep wrinkles, acne scars.  It goes deep and stimulates more collagen and ablates more tissue for more tightening.
31. ActiveFx is better for pigment and more superficial textural problems
32. Stretch Marks (Stria):  Use ActiveFx:  80-100 mj, density 1-2 (use Density 2 for thicker Stria).  Do NOT use DeepFx for Stria.
33. Melasma:  Experts are not sure it will work.  They do not recommend at this time.  They are doing test spots and experimenting with it.  Melasma is a whole topic unto itself.  Look for a specific blog about this in the future.
34. Tattoos:  DeepFx might be good for resistant Tattoos

ActiveFx, DeepFx & Total Fx Settings:

35. The experts usually treat with DeepFx in the range of 15 mj – 20 mj
36. Most experts would not go higher than density 3 with DeepFx (15%).
37. Recommended Settings: 
1. DeepFx:  15 mj, density 3, one pass. 
2. ActiveFx:  100 mj, density 3, one pass. 
3. You can go to 20 mj with DeepFx
4. You can to to 125 mj with ActiveFx. 
5. Density 3 seems to be highest density used with DeepFx (Dr. Ross goes higher, but he is very experience, an expert and he has experience with the full CO2).  Don’t go higher than Density 3 with DeepFx. 
6. For ActiveFx:  Higher density with one pass is better than lower density with two passes (Dr. Weiss).
38. To stay out of trouble with ActiveFx off the face, use Density 1 and 70-80 mj

Treating Specific Areas:

39. Eyes:  Use ActiveFx. Don’t do DeepFx around eyes (skin too thin?)
40. Eyes:  ActiveFx:  90-100 mj, density 2-3.  Downtime:  7-8 days of downtime (what TYPE of downtime?)
41. Eyes:  Upper Lid:  ActiveFx:  60-70 mj, density 1
42. Eyes:  Might consider using DeepFx for low lids:  5-10 mj with density 2?  This was the experts thinking outloud.  They are not recommending this!
43. Eyes:  Treat to the lid margins with ActiveFx:  Density 4-5, one pass (for greater tightening and because this is where much of the problem lines reside?)  This seems strong.  Listen to Webinar for yourself before doing this!
44. Neck:  Necklass lines are done with DeepFx, the rest of the neck is done with ActiveFx. 
1. DeepFx on the Neck:  15 mg, density 2 or 3. 
2. ActiveFx on Neck:  90 mj, Density 1 or 2. 
3. Neck with the above settings:  10-14 Days of downtime (what TYPE of downtime?)
45. Neck:  ActiveFx:  100 mj and density 3 was too strong.  Produced prolonged erythema.
46. Chest: 
1. ActiveFx:  100 mj, Density 1. 
2. DeepFx for sagging and wrinkling on Chest?  I think the experts recommending doing DeepFx.  Perhaps 15 mg, density 2?  Check the Webinar.
47. DeepFx can be done on neck, chest and hands

Pigment Changes, Post Inflammatory Hyperpigmentation, Melasma

48. Don’t treat Melasma (Dr. Ross)
49. Dr. Weiss has never seen PIH with ActiveFx.  The company has told a friend of mine that they don’t get PIH with ActiveFx.  This is complete and utter bull!  I have gotten PIH with skin types 4 (Italian, Greek). We need an open and honest discussion of this.  Dr. Weiss may only be treating skin types 1-3.  If this is the case, he and the company need to be much more transparent, open and honest when they talk about PIH.  What they say (you don’t get PIH with ActiveFx) is misleading, false and dangerous.  To just dismiss the PIH problem with ActiveFx is irresponsible and dishonest!  This type of cavalier attitude pisses me off!  This view (no PIH with ActiveFx is parroted by others (company reps and clinical advisors) and this type of dishonesty will get YOU & ME into trouble!  If PIH is not a problem, why isn’t ActiveFx used in darker skin types?  A friend of mine has posted his PIH pictures at www.geocities.com/pih_pih/.  Go to this site to see PIH after ActiveFx.  Dr. Weiss, I am looking forward to your comments about these pictures.  Please don’t talk about PIH if you only treat skin types 1-3!  I would also like to hear from the other Luminaries and Lumenis who claim that PIH is not a problem.  Let’s move on . . . I am calming down now.
50. None of the presenters use Hydroquinone to prevent or treat PIH.  This is because they say they don’t get PIH with ActiveFx, DeepFx or TotalFx.  Either I am an idiot or they are not being honest or they are not treating the patients that I am treating.  I am not treating any skin types 5 or 6 and I am being very careful with skin type 4.  I use Hydroquinone, RetinA and Hydrocortisone pre and post treatment on my skin type 4 patients.  Maybe I should not treat skin type 4?  Not treating skin type 4-6 eliminates about 40% of my patient population (so why should anyone buy the machine unless they live in Sweden or Finland?).  Let’s discuss this PIH issue!  Is “bronzing” PIH?  You can go to www.geocities.com/pih_pih/ to see my photos of PIH after ActiveFx.  I am interested in your comments (and I hope Drs. Weiss, Ross, Dover and Henrich will comment as well).  I think this is another case of “The Emperor Has No Clothes” (Everyone thinks that they will be called “stupid” if they don’t see what everyone says they are supposed to see. This is the question, “Do you get PIH with ActiveFx?”  If so, how do you prevent it, how do you treat it, who do you have to be careful with?  This is THE “cop out” answer that I do not want to hear, “I only have skin type 1-3 in my practice”.  This is bull (almost 50% of our population is now “patients of color” and if this is true, then YOU are not an expert using this technology!  (Just my opinion) (Sorry about the emotion, but I am fed up with the dishonest bull that comes from the companies and their luminaries.  I am on the front lines and it is me and my patients who get screwed by this type of pandering and dishonesty - hopefully one of the benefits of this type of blog will be to get the “experts” to be more thorough and honest in their presentations, you can’t be dishonest when everyone is watching and talking about your presentation!).
51. Dr. Ross uses Hydroquinone once he sees PIH.  You generally start to see PIH 15-28 days after procedure.  Wouldn’t it be better to prevent the PIH, Dr. Ross?  Can you prevent it?  Do you know who is at greatest risk for PIH?
52. Patients are generally not allergic to Hydroquinone (HQ), they can be sensitive to it.  15% of patients get irritated with HQ – contact irritation.  This is not a true allergy.  You can change the HQ to 2% OTC Hydroquinone.  Other options are to use it less frequently (every other day), use if for less time (3 hours per day rather than overnight), or use it with Hydrocortisone 1%.   (These other options are from me, not the experts).  There are also other bleaching agents like Azelaic Acid and Kojic Acid (see The Supplement to the September 2005 Skin & Aging Magazine on www.geocities.com/foxydog1064 for a Hyperpigmentation Round Table Discussion). 
53. In skin types 4 and higher (Persians and Hispanics) go a little lighter (less density, less energy).  Density is % coverage; Energy is depth of treatment.  I think both matter.  Perhaps % coverage matters more (it matters more when you do a Fraxel Treatment).
54. No one is treating skin types 5 and 6 with ActiveFx or DeepFx.  This includes Aftrican-Americans, East Asians (Japan, China) and Southern Asians (India, Middle East).  You can use Fraxel Re:store 1550 for these patients.  Be very careful to avoid PIH when you treat these darker skin types with the Fraxel. 
55. Experts:  “PIH clears very quickly”.  Me:  I have read that it can last 6 months to 2 years.  In my opinion, you should not minimize PIH by saying it clears so quickly.  Just read www.realself.com to see patients with long standing PIH.
56. Experts:  “Koreans are skin type 4”. Me:  I would treat them as skin type 5!  I wonder what Dr. Eliot Battle would say?

Downtime:

57. The experts discussed “Downtime” and “Quality of Downtime”.  Absolute Downtime, Relative Downtime & Social Downtime.  Absolute Downtime would be when you can’t go out (the day after an ActiveFx).  Social downtime would be when you don’t want to go out but can go to work (after the peeling, ActiveFx:  days 5-7). Days 2-4 are Relative Downtime, when you feel fine but don’t look to good.  You don’t want to go to work, but you can work at home and pick the kids up from school (stay in the car).     
58. We should come up with some words and definitions for the different types of downtimes so we can communicate this to our patients.  What are your thoughts on how to categorize downtime?
59. There is a big difference between 3-4 days of downtime and 5-7 days of downtime.  With 3-4 days, you can have procedure on Thursday and be back to work by Monday.  With 5-7 days of downtime, you have to take the week off.
60. The experts prefer to do TotalFx over Fraxel Re:store (1550).  They do the Fraxel when the patient prefers to give one day of downtime x 5 rather than 4 days of downtime once.

ActiveFx, DeepFx, TotalFx vs other Lasers:

61.  DeepFx and Fraxel Re:pair CO2 are the only lasers that go deep and ablate.  The others ablate shallow and then coagulate deep.  They also have spot sizes which are macro (1.3mm)  rather than micro (0.12mm)
62. The best results for deep wrinkles, vertical lip lines and acne scars can only be obtained with deep ablation
63. Experts:  It is nice to have a CO2 Laser because it has an ablative handpiece that can treat syringomas, sebaceous hyperplasia, warts and moles.  We need to start a blog which discusses how to treat these conditions and avoid scarring.  Feel free to blog on sryingomas, sebaceous hyperplasia, warts and moles!  How do you treat them with the ablative handpiece of the Encore?
64. Why Deepfx?  People were disappointed in Perioral wrinkles and lines.  DeepFx does a better job.  You may have to do 2-3 treatments, one month apart!  How much downtime would this be?  What type of downtime (absolute, relative, social)?  How do we explain this to our patients? 

Pre and Post Treatment Tips:

65. Mild moisturizers avoid acne flare-ups
66. You don’t have to use aquaphor or vasoline.  Mild moisturizers are good enough (personal communication from company reps).
67. Be careful of the lanolin in the aquaphor.
68. Using Aveeno Water Gel gets you one less day of Downtime!  (From Dr. Weiss).  What is Aveeno Water Gel?  How do we get it?
69. Post TotalFx Care:  Use “Soaks” every 3-4 hours.  (What type of soaks?  Saline Soaks (saline and gauze)?  How long do you soak every 3-4 hours?) 
70. Post Care:  Cold packs or Zimmer Cooler for 30-45 min after treatment
71. Valtrex for everyone.  One case of disseminated herpes on the face is not good.  Can we use Acyclovir?  It costs less, much less (Four Dollars at Walmart!).
72. Check all patients the next day, this makes you and them feel better.
73. Don’t give pain meds after treatment.  If they have pain, you want to know about it and see them.  They should not have pain for more than a few hours after treatment.  Prolonged pain suggests infection:  bacterial, viral, fungal.  Can we discuss post procedure infections and how to treat them? 
74. Pliaglis can be mixed with cetaphil cleanser or cetaphil moisturizer.  90% Pliaglis and 10% cleanser or moisturizer.
75. Experts worry about Lidocaine toxicity.  Compounded Lidocaine works as well or better than Pliaglis.  Pliaglis costs $60 per treatment.  Compounded Lidocaine costs about $6 per treatment.  Do the experts have a financial interest in Pliaglas?  Are the experts afraid that they will be sued if they talk about compounded lidocaine?  The discussion on this topic did not seem to be open, honest and complete!
76. Experts do not routinely use oral antibiotics unless indicated for acne outbreak prevention:   Keflex 500 mg TID, Doxycycline 100 mg BID, Erythromycin can be used to prevent acne outbreak.
77. Sunscreens:  Use everyday after skin is healed up.  Wear hat and stay out of sun until healed.
78. Use a good UVA blockers:  Neutrogena, Helioplex or Loreal Products.

The Opinions of the Transcriber (CHMD) & Other Misc Issues:

79. These experts have only been using the DeepFx and TotalFx for 6 months, so their use is evolving.  It will be very important for Lumenis to keep us informed about changes in these expert’s opinions as they get more experience.  We must all advocate very loudly and strongly for a Newsletter from the company which keeps us up to date (not just Webinars which take 2 hours to watch and are mostly for marketing and selling lasers).  Go to www.geocities.com/FoxyDog1064  for more information about Advocacy for Better Clinical Education and Clinical Exchange Programs. 
80. We must also make sure the company picks experts that have significant experience using their laser in skin type 4!!!  To say, “I don’t have the problem because I don’t have patients with skin type 4” is bull.  It is a big cop out and is counterproductive.  Plus, I don’t believe it or accept it.  Skin type 4 is Italians, Greeks and others who don’t burn but tan easily and get dark easily when exposed to the sun.  If you are not treating skin type 4, patients I am not sure you are practicing in the USA!
81. If you want to contact Lumenis directly, address all questions and comments to Amy Easterly, Product Manager.  Her email is: amy.easterly@lumenis.com.  Perhaps she can ask the Drs. Heinrich, Weiss, Ross and Dover to participate in this discussion, read this blog and comment and clarify.  I believe that they get paid a lot of money to do the Webinar.  I believe their job has been done incompletely when they leave us with unanswered questions and incomplete thoughts.  Remember, we are treating patients.  Real patients with real faces that can be scarred and hyperpigmented!!!  We want excellent outcomes with very few complications.  Lumenis owes it to us!
82. This Webinar will be available soon in Aesthetics Buyers Guide.  When?  Let’s see how good the Aesthetics Buyer Guide Version is.  I bet it will be edited to sell lasers!  Lumenis, it’s ok to do a version to sell your laser, but you should also do a version for your Encore UltraPulse Users as Continuing Education.  Let’s see if you step up to the plate for your Users!

Now let’s blog.  Let’s get it on!!!  Let’s get what we need (more self support and more company support).