In the fall season opener of “Nip/Tuck,” the sleek Los Angeles office of McNamara/Troy sat forlorn and empty, a voice-over reminding that when times are tough, one of the first things to go is the luxury of elective cosmetic surgery.

That same scene could be played out in plastic surgeons’ offices all over, as people seem to be passing up big-ticket beauty procedures — face-lifts, liposuction, breast augmentation — and seeking less expensive ways to achieve beauty ideals.

According to both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, the number of cosmetic surgical procedures done in 2008 was lower than in 2007 — by 9%, according to the ASPS, and 15%, according to the ASAPS. And although 2009 figures will not be available until late February or early March, plastic surgeons say, anecdotally, that business for the year was down at least 20% from 2008.

As a result, cosmetic surgery practices are finding themselves acting somewhat as financial consultants to their patients, helping them work out payment plans, negotiating fees and making out lists of priorities — a Brazilian butt lift can wait, but those wrinkles under the eyes need to be dealt with right away. In addition, plastic surgeons who previously only focused on the expensive and invasive procedures have had to turn their hands to the quick fixes — fillers, peels, laser treatments — which are increasingly in demand now.

Nonetheless, and partly because of an increasingly competitive job market, people still want to get work done, Mayer said, but they need cheaper options. Among them: Botox, Restylane and other injectibles that minimize wrinkles are proving especially popular and, at about $1,000 a treatment, are more affordable than the average $10,000 for a face-lift.

Experts are seeing trends across the board that are providing an insight into how people are choosing to spend their beauty dollars: Injectibles are holding their own, expensive products are not. The time between haircuts and mani/pedis is being stretched out, and massages and other body treatments are being postponed. But while fewer people are signing up for pricey liposuction surgeries, treatments such as laser liposculpture are proving popular.

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Laser Clinic MD: High Cost Treatments Taking a Backseat

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as those that send heat deep into the skin, can be used to suppress the oil glands in an effort to stop the breakout cycle.

Smoothbeam is the most popular diode laser used to shrink the size of the oil glands and suppress their activity. It heats the outer layer of the gland and creates a mild thermal injury that decreases sebum production. In addition to reducing active lesions and preventing new ones from forming, the nonablative resurfacing effect of collagen remodeling also helps reduce scarring.

Patients usually see a 40% to 50% improvement after the first treatment, but three to six are normal, with severe acne and scarring requiring up to 12 treatments.

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Lasers can shrink oil glands

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Caution for those with darker skin before you try laser hair removal….

The best candidate for light-based hair removal is someone with fair skin and dark hair.  Dark hair absorbs light more effectively, but the light can’t tell the difference between brown hair and brown skin. This can be tricky for those with darker skin types, like African-Americans, Hispanics, and some Asians.

A doctor could under-treat and get no response, or he or she may over-treat, stopping hair growth, but damaging the pigment-producing cells in the surrounding skin, leaving white spots.

Try to find a dermatologist who performs a lot of laser hair removal and also treats people with your skin color and type on a regular basis. Be sure to ask if he or she has treated others with your skin type with a fair amount of success, and what the complication rate has been.

It is also recommended that you ask how old the doctor’s technology is, since devices manufactured before 1999 emit pulses that are too short to address darker skin. Using these older machines could leave serious blistering and permanent discoloration.

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Laser hair removal on darker skin

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Laser lipo is boasting many advantages over traditional method…

Laser Liposuction is a minimally invasive, cosmetic surgical procedure which combines traditional liposuction techniques with laser treatment. Compared to older or traditional liposuction methods, laser-assisted lipolysis is generally thought to be safer, easier and quicker, providing more precise body contouring along with a skin tightening effect and minimal downtime.

Laser liposuction can be performed on many areas of the face and body, including the abdomen, arms, back, buttocks, chin, flanks, hips, knees, male chest, neck, thighs and waist. The laser enables many more individuals to be treated who previously would have needed surgery along with liposuction, often due to loose skin. Smaller areas and contour deformities not suitable for treatment with traditional liposuction are ideal for treatment with laser liposuction due to the enhanced precision of the laser. Laser liposuction can also treat areas with little or no fat like the submental area, or the area beneath the chin, as well as areas which have previously been treated with liposuction for improvement of contour deformities and skin laxity. Individuals who cannot afford the lengthy recovery associated with other treatments will find laser liposuction to be a particularly appealing treatment due to the rapid recovery and minimal downtime.

Laser liposuction is most often performed on an outpatient basis with local anesthesia, thus eliminating the risks associated with general anesthesia. Each targeted area can typically be treated in less than one hour. During the procedure, a small cannula fitted with a single laser fiber is inserted through small incisions in the treatment area. Because the incisions are small, there are no visible scars. Once the cannula is inserted, the energy from the laser liquefies the fat cells which are then drained away. The laser provides an additional skin tightening effect for improved contour, and the precision of the laser also helps to preserve the surrounding tissue.  This new approach to fat removal uses precisely controlled cooling of fat cells for removal without harming the surrounding skin or tissue. This technology can be used to safely remove fat cells near nerves, muscle and bone.

There is little downtime or recovery associated with laser liposuction and most patients are able to return to their normal routine and work within one to two days. Patients report less discomfort, bruising and swelling than with traditional liposuction. The results of laser liposuction are long-lasting with sensible diet and exercise.

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Laser Clinic MD: Laser Liposuction advantages

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In real need of some laser hair removal.

Sid Schwab’s blog has a post on young man who’d undergone surgery for a pilonidal cyst and has some comments on big hairy men, but it was this image that jaw-dropped me. High school must have been hell for this guy.

I’m guessing that if you’re offering a guarantee and this guy walks in, you might as well just close your doors. You should give your poor tech a bonus at the least.

To my knowledge, we’ve never had a patient who had this amount of body hair but then again, I’m not in the laser clinic treatment rooms.

I’m wondering if anyone has any experience with the uber-hairy?

This post on laser hair removal for the very hairy got so many spam comments I had to close them.

Post from: Laser Clinic MD

Laser Hair Removal for the very hairy.

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An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.

The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.

But Mr Mercer, who combines private practice as a cosmetic surgeon specializing in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an “unregulated mess”.

He added: “There has been a massive increase in plastic surgery marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness.”

Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that “the doctor’s first duty to protect the patient” has been forgotten in the headlong rush to cash in. “The motive for performing any procedure must never be financial gain … if we cannot self-regulate then regulation will eventually be imposed.”

Citing experience in France, where all advertising of cosmetic procedures is banned, he says: “Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines.”

Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.

“Surgery is not a quick-fix solution,” she said. “The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity.”

Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer’s warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.

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Cosmetic surgeons demand ban on advertising… cosmetic surgery!

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Within the last few years the technologies around cosmetic Fractional Skin Rejuvenation or Fractional Laser Skin Resurfacing has changed to eliminate many of the older technologies shortcomings. The erbium laser used in the Starlux is divided or ‘fractionated’ into many tiny micro-beams which treats only a portion of the skin (think tiny pin pricks) and leaves the surrounding skin intact and greatly improves the healing time.

These ‘fractionated’ treatment areas are referred to as micro-treatment zones and cause just enough injury to the layers of the dermis to trigger new collagen production and stimulate the replacement of collagen damaged by aging and sun exposure. This production of new collagen ‘fills in’ or ‘plumps’ the underlying dermal tissues and smoothes wrinkles. The surrounding, untreated skin speeds the healing process to a mere 3-4 days. Since most of the pigment cells remain intact, hypo pigmentation is effectively prevented.

Starlux 1540: Palomars New Fractional Non-Ablative Laser Resurfacing Technology

The Fraxel and Starlux 1540 are non-ablative lasers that don’t actually vaporize or remove the skin. Instead, the laser instantly heats the skin, stimulating new collagen growth.

Results for skin laxity and wrinkle smoothing are less dramatic than with ablative lasers, but the benefit of reduced recovery time and reduced side effects are mean that non ablative laser treatments are often the patients first choice.

Starlux Fractional Ablative Laser Resurfacing In The Near Future

Starlux 2940 fractional ablative lasers now provide the benefits of fractional treatments (less down time and reduced complications) with ablative skin resurfacings benefits (better wrinkle removal and facial rejuvenation) offering patients the best of both worlds.

These newer fractional ablative lasers remove tissue in the micro treatment zone instead of just heating the dermis like the old Fraxel or Starlux 1540.

The benefit of this new form of fractional laser ablation is that more wrinkled, sun damaged skin is removed than with the older laser technologies, and a better cosmetic result is attained. There is some increase in recovery time with redness and pink skin for around 5-6 days. The Starlux fractional ablative lasers still require much less recovery time than the old non fractional erbium and CO2 ablative lasers which actually burned off the top layers of the dermis.

Competing Fractional Laser Technologies

Reliant (the company that makes Fraxel) has launched a new CO2 fractional laser called Repair

Lumenis: CO2 fractional ablative lasers; ActiveFX & DeepFx

Palomar: Starlux 2940 Erbium fractional ablative skin resurfacing laser. Author Resource:- Medical Spa MD is a cosmetic medical community of Plastic Surgeons, Cosmetic Dermatologists, and Aesthetic Physicians with more than 3,500 physician members. Medical Spa MD offers wholesale Botox online and provides information on nonsurgical cosmetic medical technologies and treatments.

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Palomar Starlux 2940: Fractional Laser Skin Resurfacing

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Medical Spa MD is now publishing training manuals and books for laser clinics, plastic surgery centers and dermatology clinics.

These medical spa training eBooks are designed specifically for medical estheticians, cosmetic laser and IPL technicians and front desk staff, to provide a consistent environment for new hires and keep the staff informed the latest cosmetic treatments.

It's part of an evolving plan to be able to monetize the huge community of plastic surgeons, dermatologists, laser clinics and medical spas that are part of the community at Medical Spa MD. There are more than 4,000 physician members running laser clinics, medical spas, and skin clinics, and around a million and a half targeted page views, most of which are from physicians (although non-physician numbers are growing).

Medical Spa MD is a community that was started a few years ago and I think it demonstrates how effective you can be if you have information that is not generally available, and know how to build and motivate an online community. Medical Spa MD will never make me rich, but it's an asset that accrues increasing value over time and more than pays for itself with new opportunities.

Medical Spa RX is the sister site to Medical Spa MD and allows these same dermatologists, plastic surgeons and laser clinics to buy wholesale Botox, Juvederm, Restylane and Dysport from Canada and distribute it world wide.

But perhaps the greatest value of Medical Spa MD is simply the trust and goodwill we've grown among physicians. Medical Spa MD's influence and reach is very long, as attested to the numerous leagal threats, phone calls from lawyers, and cease and desist letters we've received.

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Medical Spa Training Manuals & Books for Medical Estheticians & Laser Clinic Staff

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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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Laser Treatments for Medical Spas, Laser Clinics, & Skin Clinics

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“Hey jeff, I have a question for you. The ads that appear on the right side of MedicalSpaMD in the “Ads by Google” space, did you subscribe to Ad Sense to get them there? Are they Google Ad Words ads, or are they from a PPC company like Yodle or Reach Local?”

We have a number of advertisers on Medical Spa MD, some of whom use Google and others who want specific placement and visibility who place their medical spa ads directly.

These direct ppc ads are used for a couple of purposes; to pay our hosting and bandwidth costs so we don’t have to charge readers, and to pay the fees for other services we use to communicate with Members and fulfill orders. On the other end the advertisers gain access to more than a million and a half page views from a pretty select member community. It seems to be working out pretty well since we’re getting an increasing number of businesses who want to become a Medical Spa MD Partner.

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Medical Spa Marketing

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