This myth might be the cause. 

"8. MYTH: Let winter-ravaged skin hibernate — cut back on pro treatments.

TRUTH:  Actually, winter is one of the best times to start in-office laser treatments like laser hair removal, as pre-laser skin shouldn't be at all tanned, and post-laser skin won't tolerate sun exposure."

To expand on this particular myth, many of Cutera's aesthetic laser and light treatments such as Titan, Laser Genesis, CoolGlide Laser Hair Removal and CoolGlide Excel Laser Vein Therapy are color-blind; they can be performed on all six skin types and can be performed year-round, irregardless of tanned or tanning skin. 

Let your patients know they don't have to wait for Spring or Summer to start laser or light-based cosmetic treatments.  In fact, they will appreciate that they can get a head-start now!

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.

This article by Rhonda L. Rundle appeared in today's Wall Street Journal. 

Interesting excerpts:  "Vanity appears to be trumping frugality in a looks-conscious society.  Despite the dismal economic climate, most women -- and men -- who undergo appearance-enhancing treatments such as Botox injections are spending hundreds or even thousands of dollars a year to maintain the regimen, aesthetic physicians say. Meanwhile, some older patients who are putting off or forgoing expensive facelifts are instead opting for less-costly injections and laser treatments."

and "Increasingly, many aesthetic patients view their treatments as professional self-preservation rather than as a personal indulgence. Appearances make a difference, says Kathleen Hudson, a 57-year-old marketing consultant in Falls Church, Va. "If you're in the business world and you want to be competitive with the younger people, you need to stay on top of your game," she says."

Lastly, "Wendy Lewis, a plastic-surgery consultant who sees clients in New York, London, and West Palm Beach, says she also advises physicians to adopt some of the same sales-promotion strategies as retailers. This holiday season, for the first time in over 11 years in business, she is offering her consumer clients a complimentary additional consultation if they purchase one between now and Valentine's Day.  If high-end stores "can send out gift certificates the week before Christmas, Ritz Carlton has deals all over, and B.R. Guest restaurants offer 20%-off gift cards, it seems only reasonable that our clients deserve a bonus, too," she tells physicians."

Wendy Lewis will be hosting an educational webinar for Cutera - details to follow shortly.

Aesthetic physicians - consider offering and marketing special packages to emphasize the importance of looking good; i.e. competitive to potential clients as a means of helping them keep or obtain new employment. 

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

 Three top dermatologists with extensive backgrounds in laser and light based procedures describe their unique experiences with the Cutera LimeLight programmable wavelength device.

Multi-Center Clinical and Technical Perspectives on LimeLight

3-in-1 Programmable Device

Christine Lee, M.D^a., Kei Negishi, M.D.^b, E. Victor Ross, M.D.^c

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.

The amount of melanin in the skin can influence the skin care treatment plan.
Accurate skin typing is very important to the success of the Laser treatment and helps to identify the client's risk of adverse events related to pigment (hyper or hypo pigmentation) .  Skin color is influenced by genetics and exposure to ultraviolet radiation.

Fitzpatrick Skin Type Chart


Certain melanin makes skin more vulnerable to sunburn

Causes of Hyperpigmentation

Topical agents used in the management of hyperpigmentation

Postinflammatory Hyperpigmentation

Perform a physical exam and ask questions

Treating Acne in Skin of Color

Aesthetic Procedures in Skin of Color

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)

Advanced skin care and Laser based technology has become increasingly popular and growing field of study for many health care professionals. Clients are requesting a number of diverse procedures when they seek our assistance. It is not uncommon to have a client who requests "Skin Rejuvenation". The skin care treatment plan may consist of skin tightening, Laser Genesis and a Limelight facial for a vascular treatment or pigmented lesions. It is quite possible that this same client may later request a chemical peel, Botox or fillers and even Laser hair removal. The diversity of the procedures requires the treatment provider to have a wide range of knowledge in order to adequately meet the client's needs. Some resources I have found to be easy to read and a very valuable resource are listed below. Of course, there are many specialized books that are available and can be found at the links listed below.

Cosmetic Laser Books

Laser and Lights Volume 2

Cosmetic Laser Surgery

R. Lierly, RN

Most laser based technology used in Dermatology creates a laser induced thermal injury by the absorption of electromagnetic energy by chromophores in the skin (melanin, hemaglobin and water). Thermal damage to structures of the skin is a combination of time and temperature, the temperature to which the cell is heated as well at the time period for which the temperature is sustained. The goal of controlling a thermal injury requires careful selection of wavelength, fluence, pulse duration and spot size. Skin color in addition to Cooling the epidermis before, during and after a laser pulse must be taken into consideration to prevent unwanted thermal injury to adjacent tissues. The failure to properly assess the client, select appropriate parameters and ineffective or improper cooling may all contribute to an unwanted adverse effect of a burn injury.

Laser hair removal, Laser vein treatment and the treatment of pigmented lesions can all result in a unwanted burn injury. The first objective in burn wound care is to dissipate the heat. Clinical evidence indicates a beneficial effect from immediate active cooling of a burn injury to dissipate the heat.
Cool tap water or saline compresses is an effective method of cooling. Colder substances such as ice can be detrimental by extending the zone of injury by constricting the blood vessels. The period of time that is required for active cooling is brief. Cooling stabilizes skin mast cells, decreasing histamine release, thereby, decreasing edema of the wound. Cooling is an effective way of controlling the pain of a partial-thickness burn. Cooling for pain control may be achieved by using moist cool compresses, not ice packs.

Treatment providers should not perform any procedure that produces a side effect that they are unable to recognize and treat. Treatment of a side effect must comply with the standard of care ordinarily used by other healthcare professionals practicing their profession in the same or similar locality and under the same or similar circumstances. The failure of a healthcare professional to observe the standard of care is negligence.
It does not matter if the burn injury was caused by an Aesthetic Laser system of some other heat source, the standard of care remains the same.
I have included several links for burn injury first aid to reference as the standard of care.
Mayo Clinic
Health Sciences Center, University of Utah
Burn Injury Lawyers
Massachusetts General Hospital

Total Burn Care

--- 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

Collect and develop your own testimonials.  Ask your patients to give you quotes.  Print them out and put them into a binder for your waiting rooms or reception.  You are going to want to protect their identity (use initials) but if they are happy with their laser hair removal treatments or their Laser Genesis treatments, they wil be happy to say so in writing.  And you will feel good after you read all the praise and positive comments. 

The goal during any Laser Genesis procedure is to methodically move the laser across a region of the face (typically ¼ to 1/8th of the face at a time) creating a localized zone of heated tissue with vasodilation.  This is visible as blushing or reddening in the area and should be maintained for a period of time.  Additionally, the patient will notice the increase in tissue temperature and the greater efficacy of each pulse.  By the end of treating any region, the patient should definitely feel the treatment.  The procedure does not require any topical anesthetic or other numbing agents meaning that it is not a painful procedure, but if the patient does not experience some discomfort toward the end of treating a region, the results may less than desired.  Once the treated region is sufficient treated (treat to erythema and vasodilation - typically ~2000 pulses), move to the next region.

To achieve proper fluence delivery, the handpiece should remain within about 1cm of the surface of the skin (about the width of your index finger).  Further away leads to beam degradation and can affect treatment.

Laser Genesis is a very deliberate procedure and should be administered in a methodical manner to achieve optimum results on wrinkles, texture, pore size, and diffuse vascular redness (blush or rosacea).  The treatment depends on both the fluence / pulse duration settings and bulk heating, which can only be obtained by focusing on regions of the face delivering uniform energy across the entire area. 

Treatments are extremely safe on all skin types, but to ensure optimal safety, always move the handpiece to prevent delivery of multiple sequential pulses to the same location.  Allow at least 1-2 seconds after delivering a pulse in any location before hitting that same location again.

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 does Pearl provide immediate results in one treatment while a Fraxel Laser Treatment typically requires 3 treatments to start seeing results and 5+ treatments to complete? The answer is in the method of delivery. Fractional laser devices only treat a small fraction of the skin with each treatment.  This means even after 3 treatments, only 50% of the skin is actually treated.  Pearl safely and consistently treats both the entire thickness and surface area of the epidermis in one treatment.  Treating the entire epidermis removes pigmented lesions, improves texture, and reduces fine lines and wrinkles - the primary signs of mild to moderate photo aging.

Pearl's wavelength (2790 nm YSGG) is the key that enables it to safely treat the entire epidermis.  This wavelength enables the laser to penetrate through the entire epidermis in a single treatment with the right balance of thermal stimulation.  During delivery, the top 1/3 of the epidermis is immediately removed and the remaining 2/3 is coagulated - meaning 100% of the epidermis is treated.  The controlled depth of heating and coagulation provided by the wavelength provides two additional benefits.  First, it provides a natural protective layer on the skin preventing any bleeding or oozing post treatment. Second, it stimulates collagen growth in the papillary dermis beneath the D/E junction. The coagulated tissue peels off after 3-4 days, unveiling a new completely re-epithelialized epidermis void of many of the signs of mild to moderate photo aging. 

This fresh epidermis is new from the D/E junction up.  This means pigmented lesions stemming from the basal cells at the bottom of the epidermis are replaced with new normal cells.  Pearl's treatment of the entire epidermis, in both coverage and thickness, provides better results on pigment in just one session than multiple IPL treatments.  Further, the body's natural response to laser treatments to the D/E junction is to stimulate new fibroblast growth.  New fibroblast activity results in collagen stimulation helping to eliminate fine lines and wrinkles.  This process occurs more gradually meaning results from a single Pearl treatment continue to improve for as much as 6 to 9 months.

Pearl's depth and three mechanisms of action (immediate ablation, immediate coagulation, and stimulation in the upper dermis) are misunderstood by many people.  Pearl provides immediate visible results in mild to moderate photo damage in just 1 treatment by utilizing these three mechanisms of action while treating the entire surface area of the face.  Further, because of the laser's controlled water absorption, treatments are safe, reproducible and consistent from person to person, removing the guess work.

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!

Let's start with an overview of the basics....

In today’s competitive environment, marketing activities play an important role in establishing a successful cosmetic practice.   Cutera has a number of aesthetic practice building tools, provided to all customers in the Cutera Success essentials marketing tool kit.  I'll share some of those tools with you.

The reasons why people need to market their services are understood, but oftentimes the particulars on the what, when, and how of marketing are less clear.

Each aesthetic practice must consider the nature, timing and extent of marketing elements that are right for them, and these will vary given different starting points, resources and personal inclinations.

Recognizing there is no cookie cutter plan, the following is offered as a guideline on how one might phase in the various marketing elements, beginning with Tier 1 and moving on to Tiers 2 and 3 as your practice grows.

Tier 1
Internal Marketing to Existing Patients
Should be prioritized above all else and be in place before Tier 2 is instituted

• First point-of-contact skills (reception/phone)
• Product and procedure training
• Patient mailings

Entry-Level External Marketing
Free or low cost efforts which are fundamental (or opportunistic)  

• Advertising in Yellow Pages - consider multiple listings including laser hair removal
• Web site - basic content on services provided, i.e. laser vein treatment and skin rejuvenation
• Networking
• Referral discounts
• Press releases - if "news", i.e. acquired new laser-based technology

Tier 2
Mid-level External Marketing

• Print Advertising
• Web site - additional content; i.e. value of skin care treatment packages
• Public speaking - present to community clubs, host evening event

Tier 3
Advanced External Marketing

• Advertising - additional venues such as radio, billboards, magazines
• Health, beauty, bridal, career and fitness tradeshows or expos
• Sponsorships
• Publicity
• Direct mail - beyond patient base

I'll go into specifics on each point separately with tips on how to apply this to aesthetic practices with laser-based technology.