Fox News reports that an enterprising Arizona cosmetic surgeon, Dr. Semone Rochlin is offering layaway payment plans to patients to enable them to afford the aesthetic treatments they desire.

"I call it a savings account for my patients," said Rochlin, 42. "Offering a payment solution where no credit is needed is a financially sensible alternative in today's market. It's my answer to the economic recession."

To read the complete article, click here.

In the article, the president of the American Society of Plastic Surgeons (ASPS), Richard D'Amico is quoted saying "It appears more consumers are choosing the less invasive cosmetic procedures because of the economic downturn".

While the article reports using layaway plans for cosmetic surgery, it could be expanded for package treatments such as laser hair removal or combination skin rejuvenation packages (chemical peels, Pearl Fractional, IPL such as LimeLight and/or Laser Genesis). 

It's time to get really creative!  Your patients will appreciate it.

Skin Inc had an interesting article on cosmeceuticals recently.  "Speaking at the American Academy of Dermatology’s academy, dermatologist Patricia K. Farris, MD, clinical associate professor of dermatology at Tulane University School of Medicine in New Orleans, discussed how to separate fact from fiction when evaluating cosmeceuticals and tips for gauging the validity of product claims."

Read the article here.

After all - a successful, thriving aesthetic practice not only offers procedures such as permanent hair reduction or skin tightening but offers PRODUCT to sell their clients. 

Don't forget to offer attractive gift certificates which your clients can use (purchased from you or part of a package gift) to give to friends and family - driving more potential clients into your practice.  Impress them with your service and attention to detail and they'll be booking procedures with you as well.

 10 Myths About Cosmetic Dermatology

Myth #10: After taking my “after pictures” for a before-and-after series, I can forget about them.

Truth #10: I need to save pictures for 7 years.

Medical images that are part of the medical record need to be saved just as long as the medical record, which in most states is 7 years. Pictures are an essential part in the billing for MOHS, as images showing the defect are needed for the medical record.

Exceptions. Images taken for educational purposes or at medical conferences that are not parts of the medical record do not fall under the ambit for the strictures involved in retaining the integrity of the medical record. (Note that this issue has not been tested in court.) The taking of pictures for educational as opposed to clinical purposes must be made clear to the patient.

Skincare Regimens to Optimize Laser Success

Advanced Skin Care and skin rejuvenation starts with careful assessment of the client and tailoring the treatment plan to address the client's concerns.

Dr. Gold emphasizes that routines be customized to each patient’s needs. “You need to look at the patient as an individual. And you need to look at what’s bothering them and what they are there for, and then come up with a treatment regimen that is useful for them before, during and after your procedures,” Dr. Gold says.

Tailoring your treatment regimens to each patient before and after laser resurfacing can be as important as the technology you choose in striving to help patients recapture the more youthful appearance they seek.

After laser treatment, skincare routines promote rapid healing, and enhance and reduce the risk of complications such as infection, pigmentary changes and scarring.

A successful Laser vein treatment is dependent on proper evaluation of the leg veins.

The visual appearance of the lower extreme ties is a useful, but not always reliable, guide to the peripheral venous condition. Multiple factors contribute to varicose veins. Intrinsic pathological conditions combine with extrinsic environmental factors to produce a wide spectrum of disease. Heredity seems to be particularly important in determining susceptibility to primary valvular failure. Occupations that require prolonged standing can lead to chronic venous distention and secondary valvular incompetence at any level. Women seem to be more susceptible to this problem, most likely because vein walls and valves periodically become more distensible under the influence of cyclic increases in progesterone. Pregnancy is an important risk factor that causes varicosities through several mechanisms. Most important are circulating hormonal factors that increase the distensibility of vein walls and soften valve leaflets. Another factor is the increase in venous capacity the develops to accommodate a greatly expanded circulation blood volume. Age is an independent risk factor for varicosities because with advancing age the elastic lamina of the vein becomes atrophic and the smooth muscle layer begins to degenerate, leaving a weakened vein that is more susceptible to dilatation. Most patients with venous insufficiency have subjective symptoms of pain, soreness, burning, aching, throbbing, cramping, muscle fatigue, and restless legs.

"Vein Diagnosis&Treatment: A Comprehensive Approach"
Robert A. Weiss; Feied, Craig F.; Margaret A. Weiss

Greater Saphenous Vein


Venous Anatomy


Varicose Veins

Laser Hair Removal&Permanent Hair Reduction

Each hair has 3 distinct components: the bulb, which lies near the insertion of the erector pili, the isthmus, and the infundibulum.

Pluripotential cells in the bulb and bulge areas cause growth of the hair follicle. Melanocytes are present in these areas. For most people, the bulb is approximately 4 mm beneath the surface of the skin (deeper in some individuals). Therefore, a considerable laser-penetration depth is required to remove the bulb.

Hair grows in cycles. Anagen is the active growth phase, catagen is the transition phase, and telogen is the resting phase. The duration of the anagen phase governs the length of hair at different body sites. Lasers are truly effective in only the anagen phase, when hair-matrix cells divide rapidly and migrate outward from the shaft and when the melanin load is at its highest. During the catagen phase, mitosis ceases, the hair matrix regresses, the papilla retracts to a place near the bulge, and capillary nourishment diminishes. In the telogen phase, the follicle detaches from the papillae and contracts to a third of its original depth, eventually falling out. The telogen phase varies in duration from one body area to the next. For example, the telogen phase may last as long as a year for hair on the leg.

The ratio of anagen follicles to telogen follicles varies with body location. Because not all of the hairs are in the anagen phase at any 1 time, laser treatment must be repeated to capture the new hairs coming into the anagen phase.

The timing of treatments is important because hair should be treated during the anagen phase. This phase is short (6-12 wk) for hair on the head, and treatments are spaced a month apart. On the trunk, the telogen phase lasts 12-24 wk, and 2-month spacing is best.

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Boom Times Continue for Cosmetic Medicine Specialists

Consumer Demand for Aesthetic Procedures Remains Solid Despite Economic Downturn  (Click on "Featured Articles" ; scroll down page and look for title)

Here is a great way to promote your practice in today's tougher market...

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.

Laser based technology and IPL technology may be used for a vascular treatment and skin rejuvenation. Clients often present with both pigmented lesions and facial veins caused by actinic damage.

Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes measuring between 0.5mm and 1mm millimeters in diameter^.
They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin.

Causes of Telangiectasia

Rosacea, acne rosacea, and actinic telangiectasia

Causes of Varicose Veins and Spider Veins

Varicose Veins and Spider Veins

Laser based technology requires that the treatment provider accurately assess client skin type. Successful skin rejuvenation may require treatment of pigmented lesions, skin tightening and Laser vein treatment. In order to minimize and manage unexpected outcomes and possible complications the treatment provider must choose correct parameters on the aesthetic laser system based on a comprehensive skin type evaluation. The Roberts Skin Type Classification System is a 4-part serial system that comprehensively identifies a patient's skin type characteristics, and provides data to predict the skin's likely response to insult, injury, and inflammation (i/i/i) for individuals of global skin types. The clinician evaluates 4 elements (phototype, hyperpigmentation, photoaging, and scarring) and assigns a numeric "feature" to each, according to established and original scales. This classification system can uniquely help determine the course of treatment, clarify postprocedure expectations, and optimize outcomes. This individualized approach to identifying features and elements in various skin types will positively impact on physician communication, patient awareness and compliance, and preventive measures.

Bio2 Cosmeceuticals treatment products are designed to enhance healing time by reducing the patient's recovery time and redness (erythema) from chemical peels and ablative laser treatments.

Laser based technology is regulated by the FDA based on ANSI standards.  Cutera is committed to safe use of  Lasers in Dermatology.  Links have been provided to help educate our clients on the Rules and Regulations associated with the use of aesthetic systems.  Some information may be directed toward Laser Surgery and may appear to not be related to advanced skin care, however, the principles of safety are the same.

USE OF LASERS/DELEGATION OF MEDICAL FUNCTIONS REGULATION BY STATE

Laws and Regulations

Current Legislation Pending by State

Directory of State Medical Boards


Laser Regulatory Agencies and Professional Organizations

Food and Drug Administration

American National Standards Institute (ANSI Z136.3)

Joint Commission on Accreditation of Health Organizations (JCAHO)

JCAHO

OSHA (Occupational Safety & Health Administration)

Association of Operating Room Nurses

American Society for Laser Medicine and Surgery (ASLMS)

There are possible complications that are associated with the use of any aesthetic laser system. A comprehensive health history including past medical history, allegies, medications, hobbies and lifestyle choices (smoking, alcohol, sun exposure) help the treatment provider identify and prevent possible complications that may occur. Accurate initial assessment, reassessment and evaluation of the intervention along with client education are key to reducing the incidence of complications associated with Laser based technology.

Laser Hair Removal can present an uncommon side effect of
paradoxical hair growth along with the more common side effects found with permenant hair reduction.

Skin Rejuvenation and Laser resurfacing complications can be classified as mild, moderate or severe. It is important that the treatment provider be able to correctly identify and treat these possible complications. Do not ever perform a treatment that may produce a side effect that you are unable to recognize and treat. Accurate assessment and client education are key minimizing many of the potential complications.

Vascular lesions can be associated with other disease processes and require the correct diagnosis of the lesion before deciding on which laser based technology would be most appropriate for the vascular treatment.

Treating pigmented lesions or using an IPL device can prove to be challengeing to many treatment providers. Performing a test spot in the area of treatment and then evaluating epidermal response 48 hours later can be very valuable in preventing unwanted damage to the epidermis ("foot printing"). However, the test spot may take 1-2 months to demonstrate the signs of post inflammatory hyperpigmentation.

R. Lierly, RN

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.

The VeinViewer by Luminetx® uses a combination of near-infrared light and patented technologies to image vascular structures, thus allowing physicians, nurses and other healthcare professionals to clearly see accessible vasculature

directly on the surface of the skin.

It's really important to correctly communicate the length of procedure downtime as well as the type of downtime; i.e. is it social downtown (redness) or clinical (i.e wounds with dressings) downtime.

If you set your patient's expectations correctly, and their downtime matches those expectations, then you have a much easier time and a happier patient. 

Using chemical peels as an example, the length of downtime for a chemical peel can vary based on the type of chemical used.  A mild peel is dramatically different than a deep chemical peel.  Trichloracetic Acid (TCA) is a common solution for medium to deep chemical peels. The depth of penetration varies depending on the concentration and amount of solution applied, therefore the downtime can vary.

Setting expectations correctly on downtime, follow up care, residual redness/dryness and expected results will help ensure that your patients are informed, compliant, and happy with their procedures - and so they refer their friends, family and colleagues to you. 

You have invested in your aesthetic practice; your equipment, training and facility.  Don't overlook a critical element to success - your staff.

Advance for Healthy Aging has a very helpful article authored by James C. Fairfield, MD on the importance of your staff.

This particular statement jumped out at me - it's vital to have your front desk engaged, asking the right questions, closing appointments and empowered to do the right thing.

"Incidentally, in our office, no one is more high-end than the receptionist. It is here that the first (and lasting) impression is made. By the time the client gets to me, my physician assistant or another provider, we already have a committed client."

Skin of Color can present with unique conditions that must be taken into consideration when developing a skin care treatment plan.
Skin of Color is highly susceptible to Post-Inflammatory Hyperpigmentation and requires special care whether performing a chemical peel or using Laser based technology to treat pigmented lesions, performing Laser hair removal, Skin Rejuvenation or a Vascular Treatment.
The Fitzpatrick Skin Type Test is very important to help determine skin type. The FitzpatrickSkin Type Test takes into consideration an individual's genetic predisposition that may not be reflected in the color of the skin but can highly influence the individual's ability to form hyperpigmentation in response to trauma or the use of an Aesthetic Laser System.

--Renee Lierly, RN

Laser based technology is both safe and effective for permanent hair reduction, skin rejuvenation, skin tightening, laser vein treatment and treatment of pigmented lesions. The use of an aesthetic laser system for advanced skin care requires the operator to be familiar standards of care and laser safety in order to be in compliance with Laser regulatory agencies such as JCAHO, OSHA, ASNI standards and state regulations.

The Laser Training Institute offers Aesthetic Laser Training and National Laser Certification. The laser course offers a foundation in aesthetic office procedures and safety.

Renee Lierly, RN

Laser Based Technology is used by Biomedical Engineers, Laser Manufacturers, Physicians, Nurses, Aesthetic and Cosmetic Laser Users. It is important to be up to date on the latest FDA regulations, State Licensing Requirements & Laser Certification whether you perform Laser Hair Removal, Vascular Treatments, Skin Tightening or do Skin Rejuvenation. However, Laser Based Technology is found in many areas outside of Aesthetic Systems. Whatever your needs are for Laser Safety or CME/CEU credits Laser Training Institute is a great resource.
Laser Training Institute
Professional Medical Education Association, Inc.
Provider Approved by the California Board of Registered Nursing
Category II CME’s for physicians

Does your practice accept credit cards? 

Do you offer information on third-party financing? 

If you answered no to either question, you may be missing out on oppotunities to increase procedures (and revenue) at your practice.

Plastic Surgery Products Online has a handy and helpful article about online resources on how to offer patient financing. 

PSP-Online has another great article about tracking your patients (not letting them disappear or move on to competitors).

"Focus on your current patient database. You could be sitting on a gold mine and don't even know it. 

Good-quality patient tracking will allow you to do the following:

• Welcome back long-lost patients who would return to you if given a chance;
• Motivate current patients to refer their friends, family, and colleagues; and,
• Encourage your patients to visit more often and to purchase products, procedures, and treatments."

Are you now offering the LimeLight Facial or Pearl Laser Skin Rejuvenation for pigmented lesion or wrinkle reduction?  Let your patients know. 

Do you have patients who now want to have laser hair removal after you  treated their vascular issues?  Remind them you can offer these services.

Do your patients have friends, co-workers, extended family members who have admired the results of your treatments?  Market your referral programs.

Put your gold mine to work for you.