Sciton and Medical Spa MD will be announcing a group buy program next week.

This is just a heads-up, but if you’re even thinking about adding a cosmetic laser or IPL to your medical center you’ll want to take a look at this new program. Sciton’s not sitting on their thumbs. They’re a motivated and hungry company that’s watched the success that some of our other Select Partners like Medical Spa RX, Shine Teeth Whitening and Frontdesk website SEO have had and decided to craft an offer that pushes the limits of what a cosmetic laser manufacturer has done before.

This could fizzle of course, but I think there’s an equal possibility that it could just change the way that cosmetic medical technologies like laser and IPLs are sold and marketed… at least by those companies who have good reputations and understand that their physician customers are their greatest asset.

For Medical Spa MD’s community this could be something of an inflection point, with one of the major technology companies now looking to actually become a member of the community we’ve built and allowing Members to pool their collective buying power and benefit from others who are using the same technology without trying to wall them off from all other information and messaging – which never really worked anyway. We’ll be discussing the details of the offer and how it came about when it launches now but I wanted to mention that it’s coming.

To bone up beforehand, read the latest cosmetic laser & IPL reviews and get a sense of what the medical spa community’s thinking about Scition, Palomar, Cutera, Solta and the rest of the cosmetic laser & IPL technologies or visit some of the physician user groups.

If you’re in the market for any type of cosmetic laser or IPL my advice is this; wait a week. Even if you’re about to buy a Palomar Starlux, Candela Smoothbeam, or even a used cosmetic IPL.

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Recently, today.msnbc.com published their list of the 8 craziest beauty treatments of the decade.  While their list certainly includes some treatments that give us pause, some of these aren’t only not crazy, some are even FDA approved.

1 – ‘Different’ facials: Facials come in all shapes, sizes and colors and may use many different materials. There are oatmeal facials, clay facials, and now – fecal facials. Some of the more extreme facial treatments to come out recently include substances many people wouldn’t want to touch, much less put on their faces, including snail secretion, human placenta, and spermine – a substance found in human sperm.

2 – Snake Massage: In Tel Aviv, Israel, you can pay $70 to have six non-venomous snakes placed on your body and enjoy what the spa calls a relaxing massage via serpent. We wonder what Indiana Jones would say.

3 – Fishy Pedicure: Customers have been paying big bucks to feed the fish. Using tiny fish imported from Asia, customers can dip their feet in the fish tank and relax while the fish feed off the dead skin, resulting in smoother feet. 14 states have banned this procedure, deeming it unsanitary as the fish are reused on multiple customers.

4 – Delicious Scents: If the way to a man’s heart is through his stomach, why not entice him with a food-inspired aroma? From flame broiled meat scented cologne to cheesy flavored lip balm, our choices in scent have grown, for better or worse.

5 – Bootylicious: Buttock Implants have grown in popularity over the past decade thanks in large part to the growth in celebrity backsides. Famously curvaceous women like Beyonce and Jennifer Lopez have inspired many women to seek out a more plumped behind and some are turning to cosmetic surgery to get it.

6 – Designer Vaginas: Vaginal rejuvenation procedures have definitely seen a rise in popularity in the past few years. Some plastic surgeons are even including this in a group of procedures referred to as the mommy makeover which often includes tummy tuck, breast lift, and liposuction as well. For many, the procedure is about getting back the pre-baby look and sensation, and is much more than vanity run amok.

7 – Bottled Baths: If water just isn’t doing it for you, how about some sake? In south-central Japan, there’s a medspa where you can bathe in your choice of different spirits including red wine or green tea. While it does sound a little different at first glance, people have bathed with salts and flower petals without so much as the bat of an eyelash. It it really so strange to think of red wine as a bath companion?

8 – Botox: One common misconception about Botox is that it is unsafe or that it’s vanity gone mad as people inject themselves with toxins. Botox has actually been around for years treating people for cervical dystonia, a painful condition which involves spasms of the neck muscles. Botox was used to relax the muscles. It is known to be highly dependable and predictable when dosed and injected properly. It is being used off label to treat migraines and TMJ. We don’t find that crazy at all.

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When it comes to the cosmetic laser field, we can sometimes feel adrift at sea with little more than a compass and the stars to guide us. We're either doing laser treatments according to our laser manufacturers' guidelines, which are conservative and often inadequate to produce excellent clinical results. Or we're trying new laser treatment settings without the benefit of knowing what other doctors have tried.

If we discover something important, we have no forum to discuss this information with our colleagues. Many of us experiment in our clinics, but we don't share our problems, successes, failures and thought processes with anyone. As a result, we make little progress because we don't benefit from others' advances and insights.

This has flattened our learning curves. Innovation-if and when it comes-is slow. This needs to change. And it begins with doctors simply talking to each other. Participating in Internet-based user groups is one of the easiest ways to do this. Such a forum allows us to share our ideas, experiences and opinions so that we can learn from each other.

The collective intellectual capacity among us, as cosmetic laser providers, is tremendous. If we all worked together, we would discover and share treatment protocols that are more effective and less painful, and produce fewer complications. We would discover better ways to reduce and treat complications when they do arise. Our field would become stronger, and we'd become better practitioners.

Unfortunately, cosmetic laser practitioners have little clinical exchange compared to other specialists, such as cardiologists. These physicians have thorough initial training with a three-year residency and a one- to three-year fellowship. They have mentors, classmates and large practice groups so colleagues can talk to one another. Publications and newsletters keep cardiologists abreast of developments in the field. They stay in touch with their academic training centers, attend meetings and are members of professional associations. In short, they communicate and connect.

What Do We As Cosmetic Physicians Have?

Contrast this to cosmetic laser medicine. Unlike cardiologists, we don't have highly developed professional networks. Nor do we have the formal advanced training. Our main professional association is the American Society for Laser Medicine and Surgery (ASLMS), which hosts a yearly meeting and produces a monthly journal. The ASLMS is a great professional society, but it doesn't serve all of our needs.

Another source of education is the laser companies, which provide clinical training, Webinars and Web sites. The trainers teach the basics, but they're limited by company protocols, which are reviewed by corporate attorneys, and designed to prevent problems rather than to get excellent clinical results.

The laser companies' Webinars are lectures designed to sell lasers, not provide advanced training. Luminaries are paid to do the Webinars, but there's no access to them for detailed follow-up questioning.

What's more, we have to sit at our computers for two hours listening to basic, redundant information to glean one useful, advanced clinical tip. The content of the Webinars are not made available in any other format?-written summary, cassette tapes or CDs-so it's not widely accessed.

If we go to aesthetic laser manufacturers company Web sites for resources, the information is basic and limited. The marketing material, of course, is fresh and current, but the clinical material is dated and sparse.

Other resources are trade publications that keep us abreast of issues in aesthetic medicine. But these magazines don't get into the details of treatment protocols and how to get the best results.

Finally, we have independent blogs, such as MedicalSpaMD.com. This blog, in my opinion, is one of the best ways to get information and find out what other providers are thinking and doing. Some doctors who blog on MedicalSpaMD are experienced users who share their expertise and opinions?, all of which are extremely helpful. But the drawback is too few physicians blog about specific topics.

Several Solutions

Working with laser companies is one way to combat this problem. Laser companies can be particularly valuable in the clinical exchange arena. These companies have the resources to start, support and nurture this activity. They know who their users are, they can enlist the knowledge of luminaries, and they have company doctors and scientists who understand the clinical applications of their laser devices. It's important to mix all of these elements in the proper environment to spur the best advances and innovations from these groups.

M. Christine Lee, MD, MPH, writes that upstanding laser companies "put more money and resources into product development than in marketing and advertising. They have a corporate philosophy that's based on building relationships.investing in new technology and research.[and] nurturing forward vision."¹

It seems almost foolish not to work with cosmetic laser companies, especially since many providers are getting clinical results that are suboptimal. Furthermore, many patients are experiencing complications that can be avoided. (See RealSelf.com for patient complaints and see MedicalSpaMD.com for physician complaints.)

Although aesthetic laser companies don't provide the clinical exchange we need, we can find useful models to emulate outside our field. For example, a medical device company produces Philips NetForum. This community connects Philips users from around the globe in a virtual users meeting so they can share clinical experiences, learn from peers and optimize results.

I'm sure many innovations have occurred when users simply share ideas and explore insights with each other via this Internet clinical forum. If we had this resource, our field would advance dramatically.

What We're Doing As Medical Spa Physicians

As a physician, I have a responsibility to take my part in this call to action. As a result, we're now forming clinical exchange meetings at our Cherry Hill, N.J., clinic. We get together twice yearly with doctors from 20 to 30 other clinics to discuss what works and what doesn't. Part of our meeting focuses on business and marketing, and the other part addresses clinical issues.

We also work closely with MedicalSpaMD.com. We are active visitors to this site and frequent contributors. This Web site is so important that we've actually bought an intense pulsed light (IPL) system based largely on the opinions of the Web site's bloggers, many of whom have had experience with several IPL systems.

We're also forming Internet-based user groups on our own. These groups discuss everything from fractionated CO2 systems to injectables to treating patients with skin of color. Doctors from around the country and the world, including Greece, Australia, France, England and India, share their opinions and experiences.

In addition, we're setting up systems in which providers who attend conferences or listen to Webinars write summaries of what they've heard. These summaries can be posted on Medical Spa MD for others to learn from. Once these summaries are posted, other providers can read them and comment on the issues they're discussing. Of course, we cannot overlook traditional methods of clinical exchange. These are still important and should be developed further. Conferences, publications, newsletters and professional associations are excellent ways to communicate and exchange opinions and experiences.

Cosmetic laser medicine is still in its infancy. We haven't yet worked out the best protocols and new technology is continually emerging.

We have to quickly learn the best ways to use all of our technology for optimal clinical results. The best way to do this is to communicate with each other so we can learn what others are thinking, doing and experiencing. When we actively participate in this learning, our field will advance more rapidly and dramatically. This will benefit all of us. True to the Chinese maxim, when the tide rises, all boats indeed rise higher.

Reference

1. Lee CM. Lasers: what every patient should know, and what your doctor probably doesn't. The ultimate guide for the best skin ever. Bloomington, IN: AuthorHouse; 2006; 163.

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What happened in medical spas, skin clinics and laser treatment centers in 2009?

Cosmetic enhancements circa 2009 can be divided into three basic categories. Non Invasive includes wash and wear injections and resurfacing treatments such as IPL & laser treatments and chemical peels, and clinical skin care. Minimally invasive falls somewhere in between surgery with visible scars, and the non invasive category, and can be performed in a doctor’s office. Invasive procedures involve surgery done to reshape or refine parts of the face and body, typically involving an office or hospital setting and anesthesia. Most common are breast augmentation, liposuction, mini face lifts and pretty much anything that involves a scalpel.

In the overall scheme of things, there is no ideal time frame to jump on the Botox® bandwagon, although the trend is certainly towards doing things earlier as a preemptive strike for maintenance and to forestall the day when everything goes south. But there will come a time when creams stop doing enough to make you content with the way you are aging, and you start to wonder what else is out there. You don’t have to take it lying down (although lying down does make sagging disappear – try holding a mirror above your head).

The next logical step from wrinkle creams and sunscreen are chemical peels, laser treatments, and intense pulsed light treatments (IPL) that can even out skin tone and improve texture.

Botox is brilliant for lines around the eyes, forehead and mouth. Dermal fillers such as Restylane, Evolence and Radiesse are de rigeur for plumping furrows, creases and deeper folds. Brown spots and sun damage can be helped with a course of Fraxel or Pearl. For slack skin, tightening devices such as Thermage and Titan can deliver a subtle lifting effect on droopy brows and necks. The final stage before considering surgery tends to be a combination of several of these to maximize the anti-aging results.

Of course, when the non invasive treatments stop delivering what you really want in terms of sagging, sinking and bulges, you might consider a short scar face or neck lift and some minor eye rejuvenation surgery to reduce excess skin and fat deposits.

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MedicalSpaRX.com sells Dysport, Ipsen's newest introduction the the cosmetic corrections market in the USA. Dysport is starting to make an impact on doctors choices to treat your wrinkles in 2009 and going forward, with MedicalSpaRX.com offering some of the lowest pricing on a wholesale basis.

(MedicalSpaRX.com is affiliated with Medical Spa MD, the largest community of plastic surgeons, dermatologists, laser clinics, and skin clinics on the web with more than 4,000 physician members world-wide.)

Traditionally the main selling botulinum toxin product for MedicalSpaRX.com has been the ever so popular Botox that is manufactured by multinational Allergan. Until recently Botox has arguably dominated the market for wrinkle corrections performed by a medical professional, as we at MedicalSpaRX.com have noted through our sales.

Of course there has also been the option to buy and use so called "fillers" such as Restylane or Juvederm since the late '90s, all of which MedicalSpaRX.com also supplies at discounted pricing to medical professionals.

Since its approval by the FDA this year, Dysport has slowly gained popularity with sales through MedicalSpaRX.com. Contributing to Dysport taking some of our Botox sales are several advantages in price and effects.

We have noted that Dysport can begin showing effects in the patient within one day of injection, whereas patients that have been treated by Botox have regularly commented saying that effects are usually noticed within a week of treatment, or in some cases within 2 weeks according to some doctors.

There is also a small pricing advantage in Dysport's favor, with pricing being an average of 5-10% cheaper than the same treatment with Botox. Although the price on MedicalSpaRX.com is higher per vial than Botox, the amount of Dysport used per injection differs and the end result is a more cost effective product.

Although gaining popularity we at MedicalSpaRX.com are still seeing strong Botox sales, which tells us that we still have a very loyal following that prefer to use the tried and tested Botox.

We would suggest to medical professionals to at least try out Dysport through MedicalSpaRX.com, who has such great pricing it can't hurt.

About MedicalSpaRX.com

MedicalSpaRX.com is an international wholesaler of pharmaceuticals and medical products to doctors, clinics and other medical organizations at discounted pricing. Amongst the products that are sold by Medica Depot are Botox, Dysport, Restylane and Juvederm. 

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The company's third-quarter earnings increased 8 percent to $179 million, or 58 cents per share, compared with $165 million, or 54 cents per share, in the year-earlier period.

Excluding special items, Allergan earned 70 cents per share. Analysts on average expected 69 cents per share, according to Thomson Reuters I/B/E/S.

The company's shares were up 1.2 percent at $54.20 in early trading on the New York Stock Exchange.

Allergan said global sales rose 4.2 percent to $1.13 billion in the quarter, somewhat higher than analysts' expectations of $1.08 billion.

Sales of Botox rose about 3 percent to $328 million, following declines in earlier quarters that the company had attributed to waning use of cosmetic procedures during the economic downturn.

For full-year 2009, Allergan forecast earnings of $2.75 to $2.77 per share, excluding special items, compared with Wall Street expectations of $2.75 per share.

The company said it expects full-year sales of $4.35 billion to $4.4 billion, compared with Wall Street forecasts of $4.32 billion. (Reporting by Ransdell Pierson, editing by Dave Zimmerman)

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Many physicians who invested in the technology believe it saved their practices from succumbing to the downfall of the economy. Soon after the approval, an array of new lipolysis technologies began to develop over time. Wavelengths were altered to find the optimal "melting point", ultrasound technology was applied, high-powered water jets were developed – all in the name of technological advancement. At that time I wondered, "What the industry could possibly develop to top this?".

It wasn't long until I received my answer! Enter, the Natural Breast Augmentation procedure utilizing fat transfer under local anesthesia! Hard to believe this procedure wasn't perfected sooner! Take the fat from one body area and put it in another – perfect! Up until this point, there was a lot of controversy regarding fat transfer. In fact, for 20 years it was denounced by U.S. plastic surgery societies as being a "dangerous" procedure. Unfortunately, this declaration was based on the technology and techniques utilized over 20 years ago. Heck, even our laptops are obsolete after 3 years!

Dr. Todd K. Malan of the Innovative Cosmetic Surgery Center in Scottsdale, AZ developed new techniques which resulted in the lifting of this "ban" in March of 2009. Many dispute the success rate for the survival of the fat after the transfer. However, with the latest technological advancements in fat harvesting, adipocyte survival rates have proven to be 85% to 90%. With the addition of adult stem cells to enhance the fat transfer and breast splinting technology, adipocyte survival rates have shown to be even higher. In fact, Dr. Malan states that when the fat transfer is concentrated with adult stem cells harvested from the patient's own fat, and is injected into the fat that is already within the breast, the result can equal a permanent increase of 250cc to 500cc in overall breast size equating to a 1 to 2 cup size increase.

Of course there are many facets to this procedure not covered in this post. I just applaud innovative technology when I see it for my own eyes. So much so, that Young medical spa (our medspa) is now performing this procedure after being trained by Dr. Malan himself and others like Dr. Jeffrey Caruth of Plano Aesthetics in Plano, TX. Technology is wonderful, isn't it?

I wonder what the industry could possibly develop to top this?

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Botox &  Dysport are now offered at almost any skin clinic, laser clinic, laser treatment center . How come?

Botox is available from nearly all skin clinics and medical spas. It’s a purified protein produced by the Clostridium Botulinum Bacterium which reduces the activity of the muscles that cause glabellar lines (frown lines) that form between the brows. The process is non-surgical, physician administered treatment used for patients from ages 18-65. Botox can last up to 6 months but results may vary and you many need treatments sooner.

A medical consultation from the physician overseeing the medical spa will be done prior to receiving treatment which will include a review of allergies, medications and possible contraindications. This will also be the time the patient’s expectations will be set about the outcome of the treatment.

Before a Botox or Dysport injection, the medical provider will determine the areas of injection by examining the patient’s ability to move certain muscles in the brow area. Tiny injections will be made into the muscles responsible for creating the lines. A cold pack or an anesthetic may be used to minimize discomfort to the patient.

There may be some mild side effects at the injection site. A small amount of pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding or bruising . Other reported side effects include headache, respiratory infection, flu syndrome, temporary eyelid droop and nausea.

Contraindications for Botox treatments are:

1. Planning to become pregnant, already pregnant or breast feeding
2. (Parkinson’s & MS) Diseases that affect the nerves or muscles
3. Antibiotics (Gentamicin, Tobramycin, Clindamycin, Lincomycin)
4. Medications for hearth rhythm problems
5. Medications for Myasthenia Gravis / Alzheimer’s disease

Dysport(Reloxin)

Dysport is a paralyzing agent approved by the FDA that’s similar to Botox in that it’s effects and treatment are the same. It’s a botulinum neurotoxin A complex(abobotulinumtoxinA) and is approved for the temporary improvement in the appearance of moderate to severe glabellar lines in adults younger than 65 years of age.

Reloxin was the previous name of the product until the manufacturers decided on the name of “Dysport” upon FDA approval. Although Botox Cosmetic and Dysport function in the same manner and have the same contraindications and results, it should be known that the dosing units of the two agents differ and; therefore, cannot be combined.

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Visit Medical Spa MD’s plastic surgery and cosmetic dermatology physician forums and you’ll step into an unlikely brouhaha that’s more than just uncommon in cosmetic dermatology and plastic surgery circles, it’s unheard of.

Medical Spa MD: Angry Cosmetic Dermatologists & Plastic Surgeons?

Growing increasingly frustrated by what physicians see as an manufactured silence and infuriating lack of clinical support from cosmetic laser and IPL companies, doctors have taken their anger public in a kind of free-for-all dog pile that you don’t usually see from physicians. A publicly viewed outing where ‘names are named’ and fingers are pointed directly at the management teams of cosmetic laser and IPL companies.

In some cases entire strings of emails are published detailing conversations (or lack thereof) and publicly embarrassing top executives and even fellow cosmetic surgeons that are acting as luminaries. It’s as though the physicians have now decided to play hard ball really hard.

Of course there’s still some self preservation and common sense left. Many of the plastic surgeons comments that are left come from anonymous doctors and the web sites that host these forums generally try to protect the plastic surgeons from hidden reprisals.

The web sites hosting these physicians forums have some headaches of their own. Medical Spa MD, the most prominent forum for physicians in cosmetic medicine, has been served with a substantial number of letters and threats from lawyers for daring to make these forum discussions public.

“We’ve received more than the usual web site’s number of nasty-grams”, says the publisher of Medical Spa MD, “but to censor public discourse between physicians is not what we’re about. The cosmetic surgeons on the site are responsible for what they post directly and commenting that they’re not receiving sufficient support is just that, their opinion.”

The issues are increasingly complicated by the types of medical answers that the most vocal of the cosmetic surgeons are demanding, leaving the IPL and laser companies in the uncomfortable position of seeming to be ignoring their cosmetic surgeons as customers, or providing information for cosmetic medical treatments that could easily be considered off-label use by the FDA, creating a potential for hazardous liability claims from patients and as well as the very cosmetic surgeons who are demanding answers.

The topic is not likely to die down anytime soon. Information that’s disseminated on the web has a long life and it’s obvious that technology companies are taking notice. In some cases they’ve actively joined in the discussion forums and proactively address concerns of individuals as soon as they’re posted, leaving an impression of active customer support. These tactics seem to be working as the IPL and laser manufactures who are active have a much lower incidence of negative comments from cosmetic dermatologists who see their calls for support go unheeded.

In the end it will come down to money. Many physicians who are opening new cosmetic clinics and looking for new IPL and laser technology are finding their way into these forums, asking their more experienced peers for advice. IPL and laser manufacturers who aren’t involved can’t expect to win the propaganda wars.

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