Leg Veins

Infrared, Laser based technology is used to treat leg veins, facial veins, permanent hair reduction. It is important to know basic Laser physics in order to provide safe and effective treatments.

Laser Physics: Back to Basics

Infrared, Laser based technology may be used to treat leg veins and facial veins.

Variable Long-Pulse Nd:YAG Laser: A New Way To Treat Difficult Vascular Lesions

Make Veins Disappear

Laser based, infrared technology may be used for a Laser vein treatment with the ability to treat facial and leg veins.

Optimizing Treatment of Small and Large Leg Telangiectasia with a Long-Pulsed Nd:YAG CoolGlide® Excel Laser

Treating Leg Veins

Infrared technology may be used to treat facial veins, leg veins and venous lakes.
Venous Lake Treatments Using the Cutera CoolGlide Excel Long-Pulse 1064 nm Laser

Some of you have asked how you can send emails to your clients.  There are a number of email vendors you can use:  Constant Contact, Vertical Response and Emma

Emma has templates to use for email and surveys that look very attractive; a nice aesthetic design is expected for anyone who works in aesthetics.

Check out Emma... 

Creating an Office ‘Oasis’

Offices that treat pigmented lesions, provide Laser hair reduction or leg vein treatment have a different environment that traditional medical offices. Customers come in for skin care treatment but also look forward to the relaxing atmosphere. Turn your medical office into an "Oasis" for skin tightening, laser hair removal and vascular treatments.

Developing a Web Site for Your Practice

Performing Test Spots serve several different purposes and are an important part of a skin care treatment plan. Infrared technology used in laser-tissue interactions produces thermal effects on the tissue.

The primary reason for performing a test spot is to observe epidermal response and to determine safe treatment parameters when treating tissue because of absorption by the chromophore. Immediate epidermal damage presents as a blanching or graying of the skin (common with the Nd:YAG). Epidermal damage may take up to 72 hours to be visibly evident especially when treating melanin. A burn from an IPL may take 48-72 hours to appear.  It is very important to perform a test spot when treating pigmented lesions.

A test spot may be beneficial for skin types IV-VI to evaluate risk for developing post inflammatory hyperpigmentation. However, this test spot must be evaluated 4-8 weeks post procedure as it takes this amount of time for the PIH to develop. Laser based technology on skin types IV-VI may increase the risk of pigmentatary changes.

Port Wine Stains require test spots as the parameters will vary widely due to the different types and involvement of these vascular malformations. Starting parameters for vascular treatments are usually lower then an average vascular treatment. A cluster of veins is a better target then a single leg vein so there is a higher risk of a burn.

There are advertisements on the internet offering "Free Test Spots" prior to Laser hair removal in order to determine if the treatment "will work before the client pays for the treatments". This perhaps could be beneficial to help determine proper parameters; however, the time period for evaluating the test spot for efficacy may be 4 to 12 weeks or longer depending on the growth cycle.

Test spots are considered an "Industry Standard of Care" and therefore have Medical/Legal implications. The elements of a malpractice suit are the "Breach of a duty that causes harm".

Informed Consent should be obtained for Test Spots and should include any potential complications that can occur from performing a test spot. It is better for the practitioner see the patient back to observe the test spot rather then allowing to patient to report on the results. This allows the practitioner to learn what the end result is and eliminates uncertainty if there is a complication.

Do you have fantastic patient results with great before and after photos?

Subject to HIPAA and patient permissions of course, you may be able to tell a compelling story to your patients and potential patients on your web site.

Take a look (and scroll down) at what Dr. Grant Stevens of Marina Plastic Surgery in Southern California did with one of his patients - an exciting case study on her great outcome.

Definitely show off your best before and after patient photos on your website and in your waiting and exam rooms but consider also listing testimonials, case studies, patient diaries and other information that shows your patients what you can do and how you do it. 

Let your website visitors know that now is a great time to start working on summer-worthy legs (leg vein treatments) or permanent hair reduction packages.  New Years resolutions often include diets - let your clientele know about Titan and that skin tightening procedures can help with lax skin.  Are you an expert in fractional skin resurfacing with Pearl Fractional?  Do you combine Pearl full face epidermal resurfacing with Pearl Fractional for deeper imperfections?  Use lasers with fillers and injectibles such as Radiesse and BOTOX?  Talk up those combination treatments and brag a little, both online and in your practice! 

Varicose Veins and Spider Veins

Varicose leg veins and telangiectasia (spider veins) are the visible surface manifestations of an underlying venous insufficiency syndrome. Venous insufficiency syndromes allow venous blood to escape from a normal flow path and flow in a retrograde direction into an already congested leg.

Mild forms of venous insufficiency are merely uncomfortable, annoying, or cosmetically disfiguring, but severe venous disease can produce serious systemic consequences and can lead to loss of life or limb.

There is a new popular patient / physician web site for cosmetic treatments titled "RealSelf.com". This web site allows patients to review products / procedures. The site then rates each procedure based on reviews. The site is gaining recognition with physicians and consumers. I heard a friend of mine mention it just the other day! It will be nice to encourage your customers and patients to use it to show the value of your Cutera Skin Rejuvenation products like Pearl, Pearl Fractional, Titan, Limelight, Genesis, CoolGlide Hair removal of dark skin types, and leg Vein therapy. This will help drive patients to your door too because there is a physician locator on this site!

If you could have your patients that have had a treatment, go to this site and fill out a real review. Site address is http://www.realself.com/. Please have them fill this in truthfully with their treatment experience. The site specifically states that it does not want "promotional" company pieces and will pull posts that are. If, however, you were treated, you represent a very valid and honest patient perspective.

There are already reviews for Pearl, Titan and Laser Genesis. Do a search for each application in the search bar and you should quickly be able to find reviews. To post a review, select "Write you review" from the bottom right of the home page, or below any procedure review section as "review it". Alternately, follow this link and fill in the form: http://www.realself.com/node/add/treatment-review

Also, please tell any people you work with that have had procedures and ask them to review the product as well. The more reviews and the more positive the reviews, the better for your Cutera technology and hopefully you can gain some new patients. If it was a demo patient that did not pay due to the nature of the treatment (training, demo, etc.) I recommend submitting the price the patient would have paid to be treated by the physician performing the procedure.

Here are the guidelines for posting at http://www.realself.com/community-guidelines

Make sure you sign up for the site for your office. Your practice and location become visible so this is a huge benefit to you if any potential customers in your area are looking at this site for cosmetic treatments. I suggest you have your customers post a review (hopefully they are predominately satisfied).

You can sign up by selecting the "Free Doctor Profile" at the bottom of the page and follow the form instructions from there

If you would like to list your practice on DermaNetwork

DermaNetwork is your premier online resource for skin rejuvenation. We offer you free access to a network of physicians who perform skin rejuvenation techniques.

Many factors contribute to the development of telangiectatic facial veins and leg veins. Age, heredity, pathological conditions, occupations that require long periods of standing and pregnancy can all contribute to development venous disease. A successfull vascular treatment is dependent upon comprehensive history including presenting complaint, active symptoms, history of vascular disease, and general health and occupation history. Varicose vein treatment may require a combination of Laser based technology and sclerotherapy to adequately address the client's needs. Any successful vascular treatment is dependent on the treatment provider being able to successfully locate facial veins, legs veins and any reticular feeder veins that are often associated with the superficial telangiectasias.

There are several tools that can aid the visualization of the superficial venous system:

Syris V600 headlamp uses cross polarization technology allows the user
to see approximately 1mm below the skin's surface. 

The new Venoscope^® II transilluminator utilizes an array of high intensity LED lights to transilluminate the patient’s subcutaneous tissue thereby highlighting the veins which absorb the light rather that reflecting it.

Pulse duration is one of the most significant laser parameters to understand. Proper pulse duration is key to a safe, consistent and effective laser hair removal or vascular treatment. For this reason, it is typically the first parameter set by practitioners. Vein treatments include facial veins, leg veins and an occasional varicose vein treatment--although varicose veins are part of a larger medical condition not treated by a non-invasive aesthetic laser system.

Pulse duration determines the volume of tissue treated by the laser. Long pulse durations treat large volumes, short pulse durations treat small volumes. As an analogy, imagine a hot iron. A person can tap the surface of a hot iron that is several hundred degrees and not feel pain or get a blister. The reason is only the most superficial cells heated up during the time their finger contacted the iron. The heat did not have time to spread deeper into the finger. Conversely, it's extremely difficult to hold a hot cup of coffee even though it's far less hot than the iron. The difference is contact time. The cup is in contact for a long time so heat has time to conduct into the finger. Another analogy that compares to laser treatments is a pot full of hot soup. The soup stays hot in the pot for a long time, but if it's poured into 10 separate bowls, the bowls of soup cool down rapidly. This is because small objects give away heat to their surroundings more rapidly than large objects.

These same concepts are used when performing a laser vein treatment or laser hair removal treatment with an aesthetic laser system. The goal of every treatment is to heat the target you want to treat, but do as little collateral damage to surrounding tissue as possible. Large vessels (like leg veins) are like a pot of soup. They heat up slowly, and also don't give away their heat to their surroundings as well as small veins. This means long pulse durations will heat the vein, but still not heat surrounding tissue. In contrast, small veins, like facial veins, are very small and give away heat to their surrounding tissue quickly. This means energy must be applied in a short time--faster than they can give away their heat. If the pulse duration is too long, some of the energy (heat) ideally meant to treat the vein is lost into surrounding tissue heating the surrounding tissue, but not the vein. So, if the pulse duration is too long, more fluence (power) is required to achieve a clinical endpoint, but some power was wasted in surrounding tissue increasing the risk of complications. If the pulse duration is too long, it becomes impossible to treat the target regardless of the amount of fluence.

Using the correct pulse duration results in the most consistent outcomes with the lowest risk of complication. This allows the lowest amount of fluence to have the greatest impact on the target with the greatest degree of protection to the epidermis. In a nutshell, every treatment wants to use a pulse duration shorter than the time it takes for the target (hair or vein) to give away heat (thermal relaxation time) and longer than the time required for the epidermis to give away heat. Pulse durations longer than 5-10 ms provide epidermal safety by the same principal that prevents a long pulse duration from efficiently treating a small vein. The longer the pulse duration, the safer it is to the epidermis, but if it's too long, it will cease to be effective on the target.

So, in summary, how does someone select the correct pulse duration? Small targets require short pulse durations, large targets respond to long pulse durations. Longer pulse durations maximize epidermal safety. The following are approximate times to help select the correct pulse duration. If the duration is within about 5-10 ms of the ideal pulse duration, the treatment will achieve maximum efficacy and safety with minimum fluence. Remember, cooling is also a critical factor effecting epidermal protection and is also required for safe treatments.

Hair Treatment:

• Fine = 5-20 ms
• Medium = 15-30 ms
• Coarse = 25-50 ms
• Very coarse = 40-80 ms

Vein Treatment (size of vein is measured diameter):

• Typical pulse durations range from 10ms to 100ms for small high pressure telangiectasias to large low flow leg veins.

How do you create a great on-hold message for your clients to hear while they are on hold?

1. Develop a script
2. Select a vendor
3. Choose a voice-over talent
4. Select background music as filler between messages
5. Buy the necessary equipment to play the message

When you are working on your on-hold script, create 4-6 short messages that promote your practice, your services, your products and your specials.  Three examples from Cutera's own on-hold messaging are:

#1.   Thank you for calling Cutera. We design, manufacture and market innovative aesthetic laser and light-based systems worldwide. Cutera systems address multiple cosmetic needs, from hair removal for all skin types to vascular therapy for facial and leg veins. Our skin rejuvenation products are the best in the industry and will improve fine lines and wrinkles, pore size, redness, skin texture, and brown spots. We appreciate your patience during this brief delay. A member of our staff will be with you soon.

#2    Cutera is the proud manufacturer of the exciting new Pearl laser. Pearl renews the skin’s surface by treating wrinkles, texture, brown spots and sun damage with fewer treatments and less overall downtime than other technologies. Pearl is an excellent, non-surgical option for those who want to refresh their skin, significantly improving overall tone and texture in just 3 or 4 days. Please go to our Pearl Web site at www.PearlSkin.com, or ask us for more information when we return to the line.

#3    Cutera is also the proud manufacturer of the popular Titan. The Titan has been featured in press coverage worldwide, including VH1, Access Hollywood, The View, Extra!, The Oprah Magazine, Harper’s Bazaar, Allure, Vogue and many others. Please go to our Titan Web site, www.titanskin.com, or ask us for more information when we return to the line.

Selecting a vendor is not difficult.  Start with members of  On-Hold Messaging Association (OHMA).  BusinessVoice is a member  of OHMA and they have a number of helpful marketing and messaging tips related to their services.  Do a search online to find a vendor that works for you.  Cutera just re-recorded our own on-hold message using a firm in Florida so don't feel you need to use a vendor in close physical proximity.  

Most vendors offer packages so you can update your messages monthly, quarterly or semi-annually to reflect new products, services, seasonal offerings, holiday messages and special discounts. 

Picking a voiceover talent.  This is subjective.  Visit your vendor's web site and listen to their talent.  Pick a voice that resonates with you and will appeal to your callers.

Selecting music to play during script interludes.  Most loops last 3-4 minutes before they repeat.  In between each script, you should have music fill the space before the next script starts, not silence.  Select music that is pleasing or soothing but not sleep-inducing.  It should fit into the ambiance of your practice.  Most vendors carry rights-free music for you to choose from so you won't have to pay licensing fees.

Equipment to play on-hold messaging can range from cassette players to MP3 players.  Your vendor should be able to assist you in acquiring what you need to play your on-hold messaging. 

Write a script, select a vendor, pick a voice and music.  It's that fast and that easy to start marketing to your callers when they call!

Telephone skills are crucial to supporting how you are perceived by the outside world, and a telephone call will no doubt be the first point of contact for new patient leads.  Think of staff members answering the phones as salespeople:  they should have people-skills, be well-versed in the procedures and, ideally, they will have at least sampled the treatments.   

Some helpful tips:

• The phone needs to be answered by the third ring, by someone who is warm and receptive and not disinterested or abrupt. You have all heard this over and over, but it's true. You never get a second chance to make a first impression, and the decision to book an appointment is influenced by whether the caller feels welcomed. If you must place them on hold, do not leave them holding for more than 30 seconds.

• The objective is to help them feel they made the right decision to call your office and that their logical next step is to book a consultation. Address their general questions informatively but briefly, without getting into the consult itself over the phone. Always try to transition back to the importance of meeting in person to discuss their particular needs and treatment specifics.

• Always ask where they heard about you, so you can track the effectiveness of your outside marketing activities.

Some helpful tools to develop:

Telephone scripts provide a general guideline for responding to inquiries.  Specifics about each procedure can be augmented from FAQ’s about Laser Genesis, Pearl, Titan, treating pigmented lesions with LimeLight Facial, using a chemical peel or treating leg veins.  Have FAQ's readily available by the phones.

Telephone tracking forms are useful to track the source and outcome of each telephone inquiry.

On-hold messaging scripts will help optimize your recorded messages.

Frequently Asked Questions (and Answers) are useful for each procedure (and system).  Offices may choose to give general price ranges on skin rejuvenation packages, for example, and offer either a free consultation or apply the consult fee to an ensuing treatment.   It's a Best Practice to not quote specific pricing over the phone.  You might quote a price for laser hair removal based on "assumed" time of treatment and find it takes much more time to treat some patients so always defer price quotes until you can see the patient or else use ranges.

Telephone scripts, Telephone tracking forms, On-hold messaging scripts and FAQs for Cutera applications are available to Cutera customers on Cutera's VIP site as well as provided in the Cutera Success marketing manual (and in softcopy on a CD in the back of the manual for customization).

Let's say that you have an existing practice with an established patient base.  How do you let your patients know you are about to acquire an aesthetic laser system, such as the Cutera Xeo with Pearl, Titan and LimeLight?  You will have the ability to treat your patients for facial veins, leg veins, laser hair removal, pigmented lesions and overall skin rejuvenation including skin tightening and laser skin resurfacing.

Wow, that is very exciting!

Your patients will be excited.  So, let them know your news in a variety of ways (most of which are inexpensive and easy to do).

   1. Signage in your waiting and exam rooms
   2. Patient education brochures
   3. Add the news to your invoices and receipts
   4. Direct mail to your patient base
   5. Reception
   6. On-hold messaging
   7. Staff evangelism

1.  Put up posters and/or countertop displays.  If you are pre-announcing, indicate that the services will be offered soon and encourage making appointments right away (before we are fully booked....).  Offer free consulations to existing patients.

2.  Brochures that educate patients are available from your vendors.  Cutera has standard patient brochures for all of our procedures and we are unique in our industry - we also have a web site where customers may order customized patient brochures.  Visit CuteraPatientTools for details.

3.  If you have a custom field on your printed invoices and receipts - add a line about your new aesthetic offerings.

4.  Send a letter with a brochure to your patient base.  Let them know what you now offer.  While it is great to target specific demographics, aethetics are of interest to most of your patients.  They may pass your brochure on using lasers for permanent hair reduction, vascular treatment, Pearl laser resurfacing or Titan to their children, parents, spouse or friends.

5.  Train your front office on your new offerings.  Give them Frequently Asked Questions (FAQs) or a phone script to use to inform, promote and soft-sell.  Consider having a sign at the front desk or have your staff wear buttons that say "Ask me about Laser Genesis" or another application.

6.  Every time you put a caller on hold, you have an opportunity to market to them.  You can record an on-hold message for a few hundred dollars.  Be sure to pick a package that allows you to update the message regularly so you include package information, seasonal treatments and holiday specials.

7.  Your staff are your evangelists.  Give them free treatments.  They need to know what the treatment feels like, how long it takes, what is needed to prepare for the treatment and be alert to the no-no's (such as tanning before IPL or using self-tanning products).  They should be so thrilled with their own results that their enthusiasm and positive comments will help create additional excitement in your patients who are considering any laser based treatments.