Laser Vein Treatment

Wendy Lewis, acclaimed author and expert in aesthetic consultancy, has a helpful article on "Instilling Loyalty in Cosmetic Patients" in the October 2009 issue of Plastic Surgery Products. 

Wendy recommends offering your loyal clients a reward program to encourage repeat business and referrals. 

Customer Loyalty Programs may include:
 

• courtesy vouchers
• offer of extra service
• complementary product
• volume discount
• refer-a-friend bonus
• discount on particular treatment
• trial of a new product or technology

Even offering a "thank you - using personal notes, calls or emails can be enough to make them feel special.  I highly recommend saying thank you after any aesthetic laser treatment such as laser hair removal or skin rejuvenation or injectible; and keep them coming back for more. 

Read Wendy's article to learn more.



 

I heard from a colleague who recently attended a customer event at an aesthetic practice.  The event was sponsored by Allergan and primarily promoted Latisse to their event attendees. 

The physician was offering a discount on Latisse to any attendee who purchased that evening or within a few days. 

I thought it was interesting that the physician did not promote her other services or products.  She sold ~10 units of Latisse at the event and of course, there will be a great opportunity to market additional services to those buyers going forward but I think it would have been a more profitable event had the physician enlisted additional vendors for support and opened up her event to more promotion.  She could have promoted laser hair removal (which can be safely performed year-round with CoolGlide Nd:YAG, even on tanned patients), non-invasive skin rejuvation (Laser Genesis, again, safe on all skin types, year-round), Titan, fillers and BOTOX. 

Open houses and customer events are a great way to have current customers (patients) bring friends and family, enjoy some wine and hors d'oeuvres while learning about new products and services and enjoying special attention (receiving goodie bags, being offered special discounts for packages paid for that evening or within 48 hours, referral $ or points if their friends/family buy product or sign up for packages). 


Customer events are great marketing tools - just be sure to leverage the event for all it is worth!

"Aesthetic medicine is an evolving field in both the medical and business arena. Commonly referenced business strategies and tactics used in retail and health care industries may not fit as well into our world. 

Retailicine is an approach that embraces the luxuries of retail while never compromising on our primary responsibility—doing the right thing medically for our patients." 

This quote is from Steven H. Dayan, MD, FACS and Tracy L. Drumm who co-wrote an interesting article, featured on Plastic Surgery Products. 

Their MICE principles are especially intriguing (MICE = Messaging, Information, Customer service and Efficiency).

Are you following these principles to successfully market your aesthetic laser and light-based services?



 

The reason for selecting YSGG over CO₂ is only strengthened when comparing YSGG to low power CO₂ lasers. Low Power CO₂ lasers (typically 30 watts and below) exaggerate the problems of CO₂ and have several independent problems as well. Histology obtained from data sheets for Deka’s SmartXide DOT and Alma’s Pixel CO₂ are included to illustrate the problems with devices that do not have sufficient power and energy density in each spot. 

Many people believe wavelength determines depth. For ablative lasers, this is not true. Wavelength determines the thermal characteristics of the laser, but depth of ablation is determined by power and energy density. With the right amount of power, all ablative wavelengths can ablate equally deep. Their thermal damage zones, however, vary significantly across devices.

A first typical problem of lower power CO₂ lasers is ablation depth. To ablate deep, lasers must have high energy densities delivered in short time periods. This requires high power. Depth of ablation is directly proportional to treatment results up to about 400-800 µm deep. Beyond this depth, there are two schools of thought. One thought is that greater depth is better, the other is that greater density is better. There is likely some truth to both. Either way, however, device should be able to treat at least 400-800 microns deep. 

In the histology image below, the image on the left shows a lesion from a single laser pulse. The ablation depth in this image is ~200µm (based on epidermal thickness of ~70µm). The histology image on the right shows a deeper treatment, but as can be seen, this required stacking 3 pulses (i.e. firing three pulses in the same location). Stacking pulses is challenging as even minor movements by the patient or practitioner can misalign the treatment holes as each spot is only several hundred microns in diameter. Further, it takes 3X longer to perform a treatment if stacked pulses are required. This means the patient experiences 3X as many shots per pass, which can reduce the tolerability of the treatment.

The second problem with low powered CO₂ devices is pulse duration. The primary problem with any CO₂ laser is excessive thermal damage. This thermal damage leads to increased potential for pigmentary complications and slows wound healing time. This is the reason all low power CO2 units were long ago abandoned for full resurfacing. This thermal damage is also a limiting factor or fractional CO₂ devices and can lead to the same complications as observed with full resurfacing CO₂ lasers if greater depth or density treatments are attempted. To properly perform a resurfacing procedure with a CO₂ laser total exposure time should be less than ~600µs to confine thermal damage. 

·        This is documented in the text “Cutaneous Laser Surgery” Chapter 6, Carbon Dioxide Laser Surgery.  In this text, it states that the thermal relaxation time for the volume of ablated tissue during CO₂ resurfacing is about 695 us and pulse durations of less than 950 us (0.95 ms) are sufficient to prevent clinically significant thermal damage

Because the laser is low powered, long pulse durations must be used to deliver sufficient energy to ablate tissue. In fact, many pulse durations as much as 100X longer than was experimentally and clinically proven optimal for CO₂ lasers.

The long pulse durations used with low power CO₂ lasers can be seen histologically in the two images above. In both cases, the coagulation / thermally damaged tissue zone is ~250-300 microns wide and deep. This means the treatment diameter of the laser is not just the spot size, but the spot size plus ~250 µm on each side of thermally damaged tissue, meaning the spot size is ~500µm wider than stated – leading to greater downtimes if treatments are performed to equivalent depths for equivalent treatment results.

The end result of minimized ablation depth, excessive thermal damage, and large effective spot sizes is that treatments are predominately thermal (not ablative), and are not very deep. Fractional non-ablative devices were completely thermal, and deeper, but required 4-6 treatments. Low powered CO₂ lasers do have maximized ablation (the only difference between ablative and non-ablative fractional lasers) meaning these treatments and results are closer to fractional non-ablative devices. Further, it is often necessary to perform multiple treatments to provide equivalent end results as highly ablative fractional devices (like Pearl Fractional). Many before and after pictures actually show results pre and post 3 treatments each spaced roughly 1 month apart.

Pearl Fractional was designed to reproducibly deliver deep fractional ablation with variable density to provide single-treatment results with maximum results and consistency. Accomplishing this and limiting downtime and complication risks required a wavelength capable of providing controlled thermal coagulation in a pulse-duration that is thermally confined. Pearl fractional was designed with sufficient power to ablate to necessary depths (typically 600-800 microns, which is ½ of maximum power). See comparison histology images below – image sizes are scaled to maintain approximately equal magnification. Histology images for the SmartXide DOT and the Alma Pixel CO₂ were obtained from product brochures from each company.

Finally some really good news:  The American Academy of Cosmetic Surgery conducted and published results from its annual Procedural Survey.
 
The most remarkable finding is the move toward non-invasive laser treatments. "During the past three years, cosmetic surgeons have seen a significant increase in both males and females electing to have laser resurfacing."

Laser vein treatment requires assessment and correct diagnosis before performing the vascular treatment.

Management Strategies for Infantile Hemangiomas


Hemangiomas are benign tumors in which growth of capillary blood vessels occurs through angiogenesis.2 They rarely occur in utero, but instead appear as bluish or red marks within the first 2 weeks of infancy. Following this initial stage, they show rapid growth lasting for up to 12 months, the proliferation phase. In the next phase, the involuting phase, they slowly regress until an average of 5 to 7 years, after which hemangiomas remain unchanged.3 Traditional management of hemangiomas therefore, has been to wait until involution occurs spontaneously. However, complications such as bleeding, infection, ulceration, obstruction of orifices or psychosocial distress may be cues for intervention.


Source: Skin and Aging

VOLUME: 17 PUBLICATION DATE: Jan 09 2009

Issue Number: 
1 Jan 09
author: Maya Barsky, BS, and Robert Buka, MD, JD

Skin Rejuvenation, Laser Hair Removal, Pigmented Lesions and Vascular Treatment

Laser based technology and treatment has advanced steadily for treatment of many cutaneous conditions, including a host of vascular and pigmented lesions, wrinkles, tattoos, scars and unwanted hair during the past decade. Demand for aesthetic treatments by skin ablation (resurfacing), and more subtle non-ablative treatments, has increased. Safety and ease of using lasers and high-energy flashlamps, has improved to the point that treatment can in some settings be given by non-medical personnel. Unwanted, preventable complications and side-effects are not uncommon. This article briefly reviews theory, clinical applications and potential for further progress of laser surgery in dermatology.

Source: Skin and Aging
 

Laser based infrared technology may be used to perform a Laser Vein treatment to hemangiomas. Treating hemangiomas is an advanced vascular treatment and should only be attempted if the treatment provider understands the anatomy and physiology of the lesion and has performed a complete assessment.

Management Strategies for Infantile Hemangiomas
 

Hemangiomas are benign tumors in which growth of capillary blood vessels occurs through angiogenesis.2 They rarely occur in utero, but instead appear as bluish or red marks within the first 2 weeks of infancy. Following this initial stage, they show rapid growth lasting for up to 12 months, the proliferation phase. In the next phase, the involuting phase, they slowly regress until an average of 5 to 7 years, after which hemangiomas remain unchanged.3 Traditional management of hemangiomas therefore, has been to wait until involution occurs spontaneously. However, complications such as bleeding, infection, ulceration, obstruction of orifices or psychosocial distress may be cues for intervention.

Maya Barsky, BS, and Robert Buka, MD, JD

Chronological aging and changes in the skin are part of the natural aging process. Genetic factors and hormones influence the skin quality and durability over time. Thicker, darker skin tends to wrinkle less.

Environmental factors such as sun exposure, prolonged exposure to wind, cold and pollution cause cumulative damage to the skin over time.

Smoking also causes skin damage over time. Nicotine causes constriction of the blood vessels that decreases the blood flow to the skin. Toxic substances from smoking affect the skin through the circulatory system and may damage collagen and elastin fibres.

Degeneration of elastin fibres and collagen fibres causes the skin to lose it's strength with subsequent loosening of the skin. These changes in the skin lead to the appearance of fine lines, wrinkles, deep facial expression lines and skin laxity. Fine lines and wrinkle are caused by the decline in the quantity and quality of the elastin fibres.

Additional changes in the skin is the gradual thinning of all layers of the skin (epidermis, dermis & subcutaneous layers). Loss of subcutaneous fat is seen in areas of the face and hands. The skin becomes drier due to the gradual decline in the activity of the sebacious glands. There are changes in hair growth with thinning of the hair on the body.

Sun exposure is the primary environmental cause of skin damage along with prolonged exposure to cold and wind. Sun exposure degenerates the elastin in the skin leading to the formation of wrinkles and loss of elasticity. Sun exposure also creates uneven pigment, formation of solar lentigines, dilated blood vessels (telangiectases), wrinkles and skin laxity.

Advanced Skin care and skin rejuvention may include skin tightening with Titan to address laxity. Laser Genesis to address texture and diffuse redness. Laser vein treatment for dilated blood vessels. LimeLight facial to address pigmented lesions but may also treat vascular issues. These treatment modalities may be combined with both Pearl and Pearl Fractional Laser treatments to address both epidermal & dermal changes. Cutera Laser based technology has been optimized to address the many issues of aging skin.

Causes of Aging Skin

Reference: "Handbook of Cosmetic Skin Care"; Avi Shai; Howard I Maibach; Robert Baran

We just returned from our annual worldwide sales meeting and one recurring theme was "think different".    Being creative, adaptive and resourceful will help us all succeed.  One thing we all have to remember - do not repeat behavior done in the past because you think the results will be different.  The results won't be different.

Plastic Surgery Products has an article here regarding taking action to facilitate change (i.e. success) rather than doing nothing and waiting for prosperity to return (being passive).

If you think doing nothing to promote your aesthetic laser treatments (like Pearl laser, Titan, Laser Genesis, etc.), great skin care products, outstanding clinic and warm staff is going to be effective at driving new patients into your practice, then you must have imbibed too much eggnog last month.  :)  You have to "think different" to get the results you want this year.

So, here is to a very active and different 2009, marketing all those great aesthetic products, procedures and techniques and having your phone ring off the hook!

Since laser light has a specific wavelength dependent on the laser active medium that emits light, protective filters that match the wavelength and power of the specific source of laser radiation are needed.