Cynosure SculpSure

SculpSure is a laser-based non-surgical treatment that apparently melts abdominal fat. The treatment is recently gaining more interest as it claims to be the first system to do such a procedure. It was only in late 2015 that the Food and Drug Administration (FDA) that the department approved the use of this treatment for patients.

During the procedure, four flat non-suction applicators and contouring frames are placed in the area where the adipose tissue cells will be burned. According to Cynosure, the company for SculpSure, the wavelength (1060 nm) has an affinity towards the adipose tissue. They use a Proprietary Energy Modulation method elevating subdermal temperature from 45 up to 47 degrees Celsius. Despite the heat, cooling is available making the patient comfortable. They claim that up to 24% of fat is reduced in a span of 25 minutes.

The company has had patients try their procedure before after one to two treatments, showing significant changes in their abdominal area. A weight change may or may not occur; even gain after 6 weeks is possible. No data regarding diet or behavioral habits are revealed which could explain the gain or loss.

Considering the effects after six weeks, a study referenced below investigated a low-laser light treatment (LLLT) done weekly in a span of six weeks. The study’s results proved to have high very satisfactory ratings (54%) for participants. Thus, the study may imply that prospective patients of laser-based fat destruction treatments may consider the effects based on the research’s findings.

Dr. Thornfeldt, Dr. Thaxton, and Dr. Hornfeldt find that:

"subjects undergoing LLLT experience no treatment-related discomfort or other post-treatment adverse effects. In addition, the six week protocol will allow[s] for a more convenient treatment plan, further increasing the likelihood of overall patient satisfaction."

Eventually, it is the patient’s decision whether to try the breakthrough SculpSure or find another one that may suit their needs (and possibly their budget). SculpSure ensures that the procedure is done quickly and after one to two treatments, with results showing after 6 weeks' time.

Study:

Thornfeldt et al., 2016

Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH
Website: www.facialplastics.org

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Interview: Anthony Youn, MD, FACS

Medspa MD's interview with Dr. Anthony Youn, MD, FACS, a plastic surgeon and author practicing in Michigan.

Physician: Dr. Anthony Youn, MD, FACS
Location: Troy, Michigan
Website: www.dryoun.com
That's interesting: Dr. Youn has been named one of the top three plastic surgeons in the United States by askmen.com and the only Michigan plastic surgeon named as a Top Doctor by U.S. News and World Report.

Profile: I am a board-certified plastic surgeon in private practice in Troy, Michigan. I am a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and an Assistant Professor of Surgery at Oakland University / William Beaumont School of Medicine.

Can you tell us a little bit about your background and how you got started as a plastic surgeon?

My first taste of plastic surgery was when I underwent major reconstructive surgery to my jaw in the summer between high school and college.  Prior to this surgery, my mandible was so large it was twice the size of Jay Leno’s and dubbed “Jawzilla.” At the time I hoped that this surgery would transform me, a skinny Asian American nerd with no nerve, no game, and no clue, into an Adonis: A ladies’ man.  Unfortunately, this surgery started a four-year dating drought, and didn’t really teach me that changing your appearance could change your life until much, much later.

My real introduction to plastic surgery came in the form of an eight-month-old boy who was mauled by a raccoon. His face was literally eaten off. The moment I saw the plastic surgeon make plans to reconstruct this poor child’s face, I was hooked. I describe this scene in great detail in my book.

I completed my plastic surgery residency at Michigan State University in Grand Rapids, a fellowship in aesthetic plastic surgery in Beverly Hills, and stared my private practice in Metro Detroit.

Can you tell us more about your practice and how it's organized?

Youn Plastic Surgery, PLLC is a private practice plastic surgery clinic. I have six employees: a receptionist, a patient coordinator/scheduler, a medical assistant, two aestheticians, a nurse injector, and myself. The office inhabits 4000 sq feet on the 12^th floor of the tallest high rise building in Metro Detroit. We offer a full range of surgical and non-surgical plastic surgery treatments, including laser treatments, injections, cosmetic and reconstructive plastic surgery.

Staff compensation is often a question for docs. How do you handle that?

All of my employees are paid hourly, with no pre-set incentives or commission. Full time employees get full benefits, including health insurance, 401K, and profit-sharing. I work with a practice management company to help with payroll and other employment issues.

What are your thoughts about the IPL and cosmetic lasers that you’re using in your clinic?

Due to my frequent media appearances, I often have new technology come through my office, usually for limited periods of time. I frequently present the newest laser and light-based technology for several television programs, and have partnered with various companies who supply them to me on a trial basis. That being said, I also own several ‘workhorse’ devices that are used on a daily basis.  I have the Cynosure Cynergy laser, which combines pulse dye and Nd-YAG lasers in one, and the Syneron eLight with Refirme, hair removal, and skin rejuvenation treatment heads. My office also uses the Dermosonic device for the temporary reduction of cellulite and a microdermabrasion machine as well.

Sound's like you're fortunate in that you're really busy which leads to the next question: How are you marketing your practice?

I’m fortunate that the only advertising I purchase is the maintenance of my three websites:dryoun.com, celebcosmeticsurgery.com, and institchesbook.com.  I’m often featured in local and national media, which has given me a significant amount of exposure. In the past I’ve used many sources of advertising, including newspapers, local magazines, internet SEO, local TV and radio, all with varying results. I find that internal advertising using Constant Contact (email software) has been our most effective means of getting the word out. The yellow pages is the one media source I recommend other providers not waste their money on.

I recently went on a book tour to promote my book which included articles in several magazines and newspapers, including Plastic Surgery Practice and Plastic Surgery News.  This exposure has been really valuable for my practice.

What treatments or services are most profitable for you?

No question, Surgery. The vast majority of the profits of my practice come from surgery. Although approximately 25-30% of the gross practice revenue stems from non-surgical treatments, approximately 60-70% of this revenue goes to supply costs, like Botox vials, Restylane syringes, and laser maintenance costs. 

Plastic surgeons, like all doctors in cosmetic medicine, usually have some interesting patient stories to tell. Do you have one that really stands out?

As a plastic surgeon, I often encounter patients whom I suspect suffer from Body Dymorphic Disorder, or BDD. Typically, I encourage them to seek counseling and avoid plastic surgery. Unfortunately, most BDD patients don’t believe they have the disorder and refuse to see a therapist. I remember a patient I’ll call “Jane.”

Jane was a librarian in her mid-forties who consulted me for eyelid surgery. It didn’t take long for me to diagnose her with BDD.

“So what would you like to talk about today?” I asked her.

“Don’t act like you don’t know, Dr. Youn. I see you staring at my eyes.  Just like everyone who comes into the library. They pretend to read books or go through the card catalogue, but the moment I look away they stare at me. I catch them doing it all the time. I need you to fix my hideous eyes.”

“What’s wrong with them?  I think they look fine.”

“Don’t patronize me. You know what’s wrong with them! I’ll pay you five thousand dollar cash to fix them. I hear you’re the best. I want you to make them perfect.”

I spent an hour trying to convince Jane that she didn’t need surgery and that she should seek professional counseling instead. She wouldn’t listen.  She became increasingly agitated. Finally she said if I didn’t operate on her, she would take a scalpel and perform the surgery on herself in my office right then! 

Cue creepy horror film music here.

I would never operate on Jane, who clearly seemed mentally imbalanced. But I wanted to say no to her as tactfully as possible. I pulled out my trump card. When things get ugly, I go to the one excuse that always defuses a situation, guaranteed to reject a patient for surgery without making her upset. 

Sadly, it’s the same excuse countless women used on me during high school and college.

“Jane, it’s not you, it’s me. I’m not ready to do your surgery. I don’t think I’m a skilled enough surgeon to make you happy.

“Really?”

“Yes. Jane, I’m not good enough for you.”

Don’t laugh. She bought it.    

Any final words of advice for other physicians running their own clinic?

I think the best advice I can give is this: When you are done with work, do things you enjoy.  As physicians, we are accustomed to delayed gratification. It’s always a challenge for us to find balance in our lives. I currently split my time between my family, my work, and writing. We’ve each undergone over 23 years of schooling to become practicing physicians, and now is the time to enjoy the fruits of our labor. Find moments of happiness in your work and at home. I think the turtle in Kung Fu Panda said it best, “Today is the present, and that’s why it’s a gift.”

About: Dr. Youn is the author of a plastic surgery tell-all, In Stitches, recently published by Simon and Schuster and  a regular contributor to CNN.com, MSNBC.com, and USA Today.  Dr. Youn has been featured on the Rachael Ray Show, Good Morning America, the Dr. Oz Show, the CBS Early Show, and many others.

Dr. Youn has authored or co-authored several papers and scientific manuscripts on plastic surgery, including such procedures as the Volumetric Facelift and Facial Reshaping. In addition, throughout his career he has conducted scientific research on a variety of topics, extending from cosmetic surgery, to laser treatments, to reconstructive trauma surgery, to HIV medications.  He is a member of the Editorial Advisory Board for Plastic Surgery Practice Magazine and has lectured throughout the country.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Cynosure & Their Legal Intimidation Department

Someone supposedly from Cynosure and using the dubious name 'Legal' has decided that posting threats against people making comments on the Cynosure Laser Users forum is the very best way to move the discussion along.

Now there are any number of dubious posts on Medical Spa MD to be sure. The straight spammers are easy enough to pick up but the 'hidden agenda' groups are around too. (I've outed others in the past.)

Here's 'Legal's' IP address lookupAnd this appears as though it's really coming from someone at Cynosure; although probably not thier customer service or sales departments.

You can see their IP address to the right >

More on that in a moment; here's what 'Legal' left as his initial comment:

ATTENTION:
Mike P did not write the above statement in regards to Mr. Leibl. The person involved with Mr. Leibl must refrain from using any executive's name at Cynosure or any current Cynosure employee's name in this forum to publicly air their differences.
Cynosure may take legal action and have all IP addresses pulled for sourcing of information, if these action do not stopped immediately.

Cynosure has no involvement with this web site and the accusation by Leon Leibl,
Paul Edmondson, Dee Greene and the fictitious employee by the name of Bob West.

It seems odd that 'Legal' wouldn't identifiy themselves if the actually worked for Cynosure; Medical Spa MD has been threatened with lawsuits many times by companies who didn't like what someone had to say and in every other instance, there's been a lawyers name attached.

This didin't only seem suspect to me. LH (A well respected regular around here) had this comment:

Legal,
It sounds as if you have nothing to say in this matter considering the fact that you have left an anonymous post and the others have left their names. Please do not try to come on her with your legal crap and try to intimidate people. This threat has been used before and did not work. If I am not mistaken these posts are over a year old and this is called free speech.
LH

Here,  'Legal's' response gets a little shrill:

Dear LH,
It's called defamation of character, not free speech when placed in this context. Establishing a statement exposing a person to hatred, ridicule, contempt, or causing injury to you in your occupation.
It isn't enough that the untrue statement was said and published, it must also have been conveyed or be published to others and understood to be about you. Figures seeking to prove defamation of character must also show that the false statement was made with actual malice

LH,
Do you care to tell us your name? Do you care to share with us your infinite brilliance of wisdom on this subject?

'Legal's obviously not been reading the site for long. (LH has bee around for more than a while and has a stellar reputation. Many of our Members, including myself, do know who he is.)

So what are we to think about Legal?

To be honest, he may have a legitimate gripe. There's a comment in the thread above that does sound as though it's written by someone claiming to be from Cynosure. However, I get emails every couple of weeks about some comment that's mistakenly attributed or where someone has revealed their business information and would like that information removed. (Although this is a hassle I try to oblige as long as it does not change any 'content'.)

I'll note here that Cynosure has not contacted me in any way. If Cynosure had, and they provided me with anything reasonable that indicated that someone was posing as one of their employees, I probably would have just removed the comment. We have a very strict policy around this. (Posting anonymously is fine; there are a lot of physicians and others who could be hurt by airing their real opinions in public. But posing as someone else will get you banned and outed.)

While it seems that 'Legal' is posting from Cynosure, it's hard to say who they are or what their motives are. (And their grammar is suspect. "your infinite brilliance of wisdom'???)

The threat that 'Legal' makes of 'have all IP addresses pulled for sourcing of information' is totally bogus. It would take a court subpoena in order to even try to get any IP addresses. The fact that the treat is even made is just stupid. 

Cynosure's business management should walk in and have a talk with 'Legal' about making corporate threats in public. I don't imagine that Cynosure reps want to be in answering questions about this thread while they're trying to demo a Smartlipo or Affirm.

If Cynosure's business or legal departments actually have an issue with someone's comment or claim that it's been posted fraudulently, please contact us directly. We're happy to help and if it makes sense we'll remove it. But don't just go around threatening and trying to intimidate others on Medical Spa MD forums... you'll make the front page and get your IP address banned... as in this case.

Cynosure Links:

• Cynosure Laser Users
• Cynosure Acclaim vs Candela Gentle Yag vs Laserscope Lyra
• Cutera vs. Cynosure
• Cynosure: Elite, Affirm, Cynergy & Smartlipo
• Problems with cynosure affirm laser

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.