Plastic Surgery Statistics: What's in a Number?

The American Society for Plastic Surgery released their 2008 statistics on cosmetic procedures performed in the U.S. and stated there is a 12% decline in the number of surgical and non-surgical procedures.

The ASAPS reports the top five non-surgical cosmetic procedures are: 

1. Botox Cosmetic - 2.46 million procedures, down 11%
2. Laser Hair Removal - 1.28 million procedures, down 9%
3. Hyaluronic Acid Fillers (including Restylane, Perlane, Juvederm, Hylaform) - 1.26 million procedures, down 13% (is Radiesse and other fillers included in this research as well?)
4. Chemical Peels - 591,808 procedures, up 3%
5. Laser Skin Resurfacing - 570,880 procedures, up 12% 

According to the ASAPS, breast augmentation has now taken the number 1 spot over liposuction. Here’s the top 5 surgical rankings for 2008 as compared to 2007: 

1. Breast Augmentation - 355,671 procedures, down 11%
2. Liposuction - 341,144 procedures, down 25%
3. Eyelid Surgery - 195,104 procedures, down 19%
4. Rhinoplasty - 152,434 procedures, not much change
5. Abdominoplasty - 147,392 procedures, down 20%

It’s no surprise this decline is directly related to our economical status, but to what extent? Is the economy actually discouraging people from having procedures performed, or, are they simply making more financially sound choices? There have been major technological advancements in the arena that is aesthetic medicine and I found it interesting that the research did not mention these newer procedures performed by plastic surgeons, as well as non-core physicians.

While liposuction numbers are down; it appears as though the number of body shaping and sculpting procedures in the U.S. is on the rise as evidenced by all of the new devices at ASLMS and THE Aesthetic Show, our own data in our practice, and the new laser lipo centers popping up all over the place.

As patients become more educated about the newer procedures available, they now have the advantage of making an educated choice to forego general anesthesia, the lengthy time off of work for recovery, and the high price tag that comes with liposuction and tummy tucks, and are choosing to have minimally invasive procedures instead.

Maybe these newer procedures are so far down on the list that they weren't worth mentioning? Or, maybe the ASAPS’s data is not truly reflective of the current practices of aesthetic medicine in the U.S. as performed by all aesthetic physicians? I’d like to see the ASAPS, along with their “independent research firm”, realize that other physicians besides plastic surgeons perform a variety of aesthetic services that are continually evolving into more cost-effective, efficacious and safe procedures for today’s savvy consumers.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Beware of the Botox Bandit

Botox, Restylane, Juvederm, Thermage... We all have probably had our fair share of clients addicted to aesthetic treatments.

While the patients we deal with daily are probably not addicted to cosmetic medicine to the caliber of the “Cat Lady”, but close enough where you begin to wonder if they are suffering from body dysmorphic disorder. Especially in the category of injectable dermal fillers or laser resurfacing, you probably had to turn one or two clients away who you felt, as a professional, were pushing the boundaries of what is considered aesthetic enhancement versus disfigurement.

Many times these clients will shop amongst a variety of aesthetic physicians in and out of their area often having multiple services performed in a fashion deemed possibly dangerous. The cost of multiple procedures during our current economic status have forced some to turn to the unsavory practice of shoplifting. These thieves are very clever in their tactics, cunning in their role playing, and are worthy of the tile “Botox Bandit”.

I’m sure you have read news articles about Botox Bandits and, unfortunately, the number of Botox Bandits in the U.S. is on the rise! I have had several conversations with clinic owners across the Country who have been a victim of these cunning criminals. One clinic owner in California told me of a client who came into his practice, had her treatments and, while at the checkout counter, stated she forgot her credit card in her car. In good faith, she left her designer purse at the counter for the staff to hold while she quickly ran outside. Well, you don’t have to be a rocket scientist to figure out what happened next! After the client failed to return, the staff looked inside her so-called “designer” purse and found it to be empty. That, and it also was a counterfeit purse. Score one for the Botox Bandit.

Theft comes in many forms. Blatant like the case described above and more subtle in the form of complaints. Some clients have mastered the art of complaining to the point where they know they will end up with free services to appease them. Some even push the boundaries so far that they demand their money back after they have had all of their treatments, and then some. They will even be arrogant enough to post an undesirable posting about you on the web.

So, which form of theft is worse? The "Botox Bandit" or the "Scheming Thief"?

Do you have the right to discharge a patient from your practice only to suffer the undeserving web postings from your anonymous spurned patient? I do know this, it has caused us, and many practices like ours, to ask for payment before services for new clients we don’t have a relationship with.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Laser Lipo ~ One Lump, or Two?

I like to regularly read through various self-help forums to understand the patient’s point of view on the types of procedures we perform. (Laser Lipo, SmartLipo) I believe in doing so, it can help fine tune our procedures, prepare us better for responses to patients with similar experiences, and help us perform overall better customer service.

One of the common complaints I have continually come across was lumps and bumps patients have experienced post laser lipolysis. Many seem somewhat traumatized by the bumps, others state their physicians have given them no explanation or even treatment for the lumps.

Let me first preface that this is in no way comparable to the lumps and tracts after traditional liposuction for reasons we’re all well aware of. In fact, many of our patients are coming in to have those lumps and tracts removed with laser lipo. Patients need to be well educated about the healing process of the lymphatic system, underlying tissue layers, the remaining layer of fat post laser lipolysis, and that lumps can be part of that process for some. How many lumps remain visible after the healing process has been completed (6 months or more) is dependent upon how much fat was left underneath the skin from the procedure, how aggressive the procedure was (amount of fat removed and severity of manipulation), and how the area was treated during the healing process. These lumps can be pockets of just fat, or consolidation of scar tissue and body fluid, even seromas that require regular draining until gone.

It doesn’t matter if the device used was a lipo lysing laser or the ultrasound Vaser, lumps can occur and tend to be more operator dependent than anything. No surprise to any of us, I noticed with many physicians I talked with experienced more lumps at the beginning of their training and had to bring many patients back for touch-ups. These physicians tell me that as their experience level increased they began to see fewer lumps and attributed the reduction to technique enhancements from training with more experienced physicians, choices of suction devices and cannulas, aggressiveness of suction post lysing, and post treatment regimens.

Because you can’t rush a physician’s level of experience, what you can do is offer your patients methods to help keep the lumpy bumpies away. These treatments can be started as early as 2 weeks post-procedure or as early as tolerated by your patient.

Here are some of the laser lipo remedies that we currently use or have been suggested to me by others.

• Proper garment fitting
• Placement of large foam surgical pad across abdomen under garment to disperse pressure evenly
• Lymphatic massage, or deep tissue massage, by an experienced massage therapist
• Use of a roller ball. We like the Omni roller ball suggested to us by our dear friend Dr. Richard Goldfarb (thanks Rich!)
• Ultrasound therapy
• VelaShape, or comparable device. We give our patients 2 free sessions with every laser lipo procedure. We like the blending of the infrared, radio frequency, roller motion and suction to help our patients smooth out and tighten the skin.
• Endermologie
• Use of a small cannula to excise the areas of fat (plastic surgeon suggested)

More theories and suggestions are welcome!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Chemical Peel Your Way to Increased Med Spa Revenue

Whether you’re trying new medical spa marketing endeavors to promote your current services or contemplating new laser technologies to add to your armamentarium of non-invasive or minimally invasive procedures... the point is, you’re trying to increase your practice’s revenue during these challenged economic times.

Patients are feeling the economic struggle as well as they want to keep up their aesthetic needs while trying to cut costs. I’m sure that many of your patients are very loyal and offering them cost-effective treatments can be a plus for both of you!

In looking at my husband and business partner (the only physician in our practice), he’s pretty much strapped with what he can do in the course of his day. Fitting in injectables between laser lipo cases and laser cases can be tricky scheduling! Without having to hire additional personnel, or invest in expensive equipment (all that increase your overhead), one thought we have adapted is to use the staff we already have to help increase our revenue.

One of the ways we did this was to increase our variety of chemical peels we offer to our patients. Some patients decide to forego the Palomar Lux1540 or Lux2940 treatment plan we offer due to cost or even downtime of the Lux2940 (it’s really only a few days, but to some people they can’t afford to take off work that much).

Enter, the chemical peel!

The good, old-fashioned chemical peel has come a long way, but it’s still a tried and true facial resurfacing procedure that can tighten pores, remove dyschromias, and even smooth skin texture. They can be performed in a wide range of intensities and depth. Deeper peels can be performed in the office while others can be worn home to be removed by the patient several hours later. You can step up the peels to get faster results, or more gradually. Plus, it gets your client valuable face-time with the aesthetician who is experienced in your skin care product lines and upselling procedures the client may truly benefit from (i.e., Botox, fillers, IPL photo facials, etc).

Whether it be TCA Peels, AHA Peels, or even a Jessner Peel, peels are a wonderful service to offer in the springtime as your clients want to shed winter dry patches to reveal a more healthy looking glow!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Stepping Your 'Smart Lipo' Laser Clinic Out Of The [Branding] Box

Let's say you needed a tissue and asked a friend for a Kleenex... would you be perturbed if they handed you a Puffs instead?

Silly point, but it seems to be somewhat of an ethical conundrum that I came across at ASLMS while talking with a group of physicians who are contemplating adding laser lipo to their already successful aesthetic practices and are unsure of how to market it.

Let’s face it, there have been quite a few technological advancements since the FDA approval of the first SmartLipo in November of 2006. There’s ProLipo, Vaser Lipo, SlimLipo,... let me take a breath here... Cool Lipo, LipoLite, Lipotherme (I know I have omitted some, but you get my point).

Since SmartLipo was first to market, it has now become a household name like Band-Aid or Clorox even though we know there are more brands of those products. In fact, the same situation is going to happen once Reloxin is released.

These physicians made a valid point when they stated patients are calling in asking for “SmartLipo”. So what if the physician decided they want a different laser lipo device? How would they market it since the public is primarily only aware of “SmartLipo” and are specifically asking for it?

Ethics suggest to me to market it as “laser lipo” and that use of the name “SmartLipo” would not only be misleading, but probably even illegal for false advertising. So what’s a physician to do if he wants different technology? What’s the best marketing strategy?

• Purchasing a used SmartLipo device on eBay, perhaps, just to say they own one?
• Advertising your device as a “SmartLipo-like” device?
• Co-purchasing a SmartLipo device with another practice?

It definitely proves the point that first-to-market has sustaining branding longevity.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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ArTek ~ ThermoTek: How to Stand Out in the Crowd

I just returned from attending the ASLMS conference in Washington, DC. The cherry blossoms were in full bloom and the laser and IPL manufacturers were in full force!

As expected, all of the companies displayed their equipment there for us to see and play with. With the current technology present, came the vision of new technologies balancing on the horizon. One can almost envision the progression of technological development when you're at ASLMS as all of the companies seem to be racing to release that next perfect modality that will change the face of aesthetic medicine as we know it.

What presence these companies displayed with their engineers and physicists standing along side of their sales force. Once, where you would discuss the steps of treating various conditions, you now find yourself discussing, and more curiously, understanding the importance of discussing pertinent wavelengths and wattage.

I can seriously envision one day stepping into a sort-of tanning booth, being hit with a flash of laser light, and stepping out of the booth with 3 inches of fat shed from my waist. Almost reminiscent of the Jetsons, this technology is truly within our grasps! Parents sending your children to college for the first time, relish in the thought of them becoming engineers or physicists for they surely will have a booming career in aesthetic medicine!

One cannot peruse through Medical Spa MD without coming across the gripes and concerns of disgruntled laser owners completely dissatisfied with how they were handled and treated after the sale. I, for one, would like to give you a story of hope by posting some positive words for a change about a little company with a big conception of customer service. So much so that it should be a considered a text book gold standard for anyone struggling in today's aesthetic market

I'd like to tell you about ArTek, the manufacturer of ThermoTek, an air chiller we use for laser skin resurfacing. In shipping back to the company for firmware flashing, the carrier dropped the box and smashed our unit. Busy as we are in our practice, no one thought to add the extra insurance and the carrier only was responsible for $100 of damage. We were now out $5000 just like THAT!

ArTek had such compassion for our situation that they completely took care of us and rushed repairs to the unit, as well as expedited shipping, so we could have it back in time in our office for our patient's resurfacing procedure.

I saw them at ASLMS. I walked up to them and extended my hand and introduced myself. They knew who I was and recounted my plight. I sincerely thanked each one of them personally for caring enough about my situation, about my patients who needed this device for comfort, and for forgoing the cost of the repair bill due to the shipping company's error.

To all of you laser companies, (and you know who you are as you've already been singled out!) take notice of this excellent display of customer service. THIS is how you take care of your customers and THIS is how you stay a leader in the aesthetic marketplace. 

Great technology is good for about 3 years...

Outstanding customer service lasts a lifetime!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Med Spa Marketing: To Twitter or Not To Twitter

Medical spa and laser clinic marekting? You may want to be on social networks like Facebook and Twitter.

It’s no secret that a creative way to market your medical spa or laser clinic is by participating in social media marketing (SMM) such as Twitter, Facebook, MySpace, YouTube, Digg, Craig’s List, etc. These types of sites give users a virtual voice on the internet. At our practice, we have a huge amount of referrals from friends or family members. In the same manner, these types of sites allow people to share information and recommend your practice to others. Let’s face it, most people like to check out your reputation before they schedule an appointment and SMM sites allow for an excellent forum to do so.

Just listing yourself on SMM sites with a link back to your URL won’t help your SEO ranking much unless you actively use them to build your brand recognition which, in turn, leads to improved linking to your website. The main problem is, keeping yourself current on SMM sites is time consuming and many physicians barely have time to answer their email let alone update all of these sites on a regular basis! In fact, I am extremely impressed at how many physicians are active on Medical Spa MD!

To get started, your best tactic is to investigate who your target audience is in demographics, then compare that data to different SMM sites that fit your target. Once established on these sites, you have to continually engage your audience with interesting content, perhaps chats, or mini blogs. It does take time and diligence, but the reward is building your brand awareness and uniqueness from other practices in your area.

Making your site mobile ready enables users to follow you on SMM sites easily (visit my mobile site from your handheld device at www.YoungMedicalSpa.mobi (if you try to visit from a PC you will be redirected to my dot-com site).

I truly believe SMM can help with your global link popularity which is essential to your SEO rankings. Unfortunately, it’s difficult to determine which venues are converting users to actual revenue. I monitor referring sites using Google Analytics - a very valuable tool!

I work hard at keeping up with all of these SMM sites and have to build a schedule to follow just so I don’t forget. Is it worth investing your time? I say absolutely! That, or hire a teenager to do it for you.

Follow Medical Spa MD on Twitter

Follow Paula; Young Medical Spa on Twitter

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Update

on 2009-04-01 20:04 by Paula D. Young RN: Medical Spa

Twittering and social media marketing is the key focus in April's digital edition of Cosmetic Surgery Times!

http://www.nxtbook.com/nxtbooks/advanstar/cst_200904/#/2

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Protect your reputation. Get new patients. Medical Spa MD Members receive a special, full service Podium account that includes: no setup fee (save $300), a 10% discount forever (save $330/year) and on-demand patient review marketing training for your entire staff ($597 value).  This offer is not available anywhere else.

Medical Spa & Laser Clinic Coupon Shopping

Medical spas seem to be opening up everyday, or more physicians are adding cosmetic services to their practices and adding the phrase “medical spa or laser clinic” to their practice name. Whatever the cause of this increase in “competition” the fact is the more players there are, the more you have to step up your marketing campaign.

Potential clients have no idea who is “better” than whom, or who has the most experience, or talent. Point blank, their main concern when choosing a medical spa service provider is price. We have price shoppers calling everyday asking how much we charge per unit of Botox, or per syringe of a particular dermal filler. It amazes me that "A", Botox and fillers are so common and are injected in so many different types of practices that someone actually CAN price shop. And, "B", it amazes me that someone doesn’t even ask who is performing their injections and how much experience they have had. Since when is cosmetic medicine categorized like shopping for a handbag?

Here’s the conundrum we’re facing in our medical spa... laser lipolysis is our number one aesthetic service in our practice. So many physicians have added laser lipolysis to their practice in the hopes of generating revenue and, unfortunately, are having a difficult time getting business in the door that they’re offering ridiculous price breaks or coupons worth a very high dollar amount. What the unsuspecting client doesn’t know is how high they jack up their service price to allow for the coupon deduction. Plus the client knows nothing of the practice, who’s performing their procedure, etc.

We have recently had clients come in for complimentary consultations and asked us if we would honor our competitors coupons. My staff was taken a little off guard not expecting such a request.

My stance is that this is a medical practice, not a boutique, and there is certain room for negotiation in pricing, but honoring a ridiculous coupon just to get someone’s business isn’t worth the reputation we’re trying to maintain as medical professionals. Granted, some clients take their coupons away in a huff and say they’ll go elsewhere and only under my breath can I say you’ll get what you pay for!

I’m curious to know how other medical spas handle competitor’s coupons. Is there a limit to what you will accept, or particular services you’ll negotiate on? How far are you willing to go to acquire new clients?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Medical Spa MD Members get a Podium patient review marketing account and save $1,257

Protect your reputation. Get new patients. Medical Spa MD Members receive a special, full service Podium account that includes: no setup fee (save $300), a 10% discount forever (save $330/year) and on-demand patient review marketing training for your entire staff ($597 value).  This offer is not available anywhere else.

Shining The Light On LED Therapy

Sales must be down because I have been getting inundated with sales reps cold calling my office telling me how our practice can improve the therapeutic outcome of many of our services merely by adding LED light therapy.

I have spoken to some other practices and get mixed reviews when discussing LED therapy. Some feel it is highly beneficial while others think it verges on the level of witch-doctory. The FDA states that LED technology with a low-level output is determined to be of “non-significant risk”, but has it been determined to provide any significant improvement specifically in the medical aesthetic arena?

I, personally, am skeptical as to whether or not a wavelength of LED light can actually make an improvement in certain conditions we currently treat in our practice. I’m not talking about infrared light for purposes such as skin tightening or blue light used in conjunction with Levulan® kerastick photodynamic therapy for the treatment of acne.

Every company I speak with has their spin on the product. I understand spin, I used to teach sales reps how to spin. What matters to me more is clinical data that suggests there are actual improvements in skin tone, texture and clarity. That there is alleviation of wrinkles, and lightening of dyschromias from acne, melasma, or from environmental causes. Call me a non-believer, but I value a doubled-blinded study far more than I do anecdotal experience.

Reps are telling me that LED therapy is used highly successfully as a stand alone therapy or as an adjunct to laser services. They now claim to have therapeutic advantages post laser lipolysis claiming it reduces erythema, edema and bruising. Come on! Really? Where’s the data that suggests that? Does it provide more of a psychological benefit to the patient than it does physiological? If so, patient selection is as important as in hypnotherapy!

Information on the web has revealed the following cosmetic indications where LED light therapy has been “known” (how it’s known I’m not sure) to provide benefits: burns, scrapes, pain relief from skin injury, prevention of bruising, inflammation (if a fresh injury), and, wound healing (such as after a laser peel or resurfacing procedure).

Some conditions where LED light therapy is believed to have some benefit for is: Red LED for the treatment of Rosacea, anti-aging, sun damage, dyschromias, existing bruises and inflammation, psoriasis, eczema, dermatitis, and, poison ivy. Yellow LED for wrinkles, and blue LED for the treatment of acne.

The Rosacea Support Group’s website at http://rosacea-support.org, states some very compelling information about the major players in the LED therapy market and various physician testimonials as to their therapeutic benefit.

Curiosity has truly consumed me on this topic; therefore, my question for discussion is this, does a device such as the above discussed, have to be FDA approved to substantiate a claim of efficacy in your eyes? And, is an FDA approval important to you when selecting modes of therapy for your practice?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Laser Clinics & Plastic Surgeons: Can I call you sometime?

Dear Physician and Medical Aesthetic Practice Owner,

You attended numerous training and certification courses, hired a top notch staff, have the latest products and equipment, designed an aesthetically astute office environment, invested in a comprehensive marketing strategy, and probably hired some consultants along the way. So the million dollar question is... who’s answering your phone?

Your entire investment was focused on getting new patients in the door, but let’s face it, they just don’t walk in, they call first. Surveys show that more than 80% of all business transactions involved a phone call at one point. And, if the person on the other end of that line doesn’t have the right demeanor, personality, knowledge base and selling skills, you might as well list your lasers on eBay.

Are the associates responsible for answering your phone pleasant, easy to understand, knowledgeable about policies and procedures, know how to effectively utilize the HOLD button (if absolutely needed!), how to leave a message, how to get consults in the door, and, most importantly how to handle a difficult caller?

This is truly a marketing and business strategy you should be focused on even more so than what form of advertising you should use. Advertising only works if you can get people in your door.

At our laser clinic, we use effective strategies to help our associates take ownership of what they do. All of our associates responsible for phone calls are trained on all our procedures and FAQs of the procedures. They also need to know our website and menu of services inside and out. We have phone scripts at a finger’s touch and I ask them to smile when they answer the phone because it will show in their voice.

It may seem like a “Big Brother” tactic to most, but I have randomly recorded calls through our pay-per-click campaign which helps me take a quick pulse of what their strong points are (so they can be praised) and what their weak points are (so I can redirect them).

In the long run, we all win. We’re getting solid leads coming in the door and they receive bonus checks for consults they have been able to schedule from cold calls. It truly gives them a feeling of ownership and accomplishment!

So, can I call you sometime?

Regards,

Mystery Caller

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Laser treatment? Skin clinic? Who's in charge here?

It’s happened in Florida and now in Massachusetts. State legislators and physicians are trying to establish some guidelines and laws to protect the public from sustaining injury by unlicensed or untrained service providers.

We’ve read the of the lipodissolve horrors where people are offering lipodissolve, laser treatments and botox in their garage for heaven’s sake! It’s hard to believe it has come to this, but cosmetic medicine has turned into a “cash cow” for anyone!

I’m getting so sick of the turf wars amongst doctors of which specialty should be doing what... I mean seriously... can’t you all get along? Instead of fluffing your feathers to establish dominance over cosmetic medicine you should ban together to eliminate the bottom feeders who are performing services in their garages to protect the practice that IS cosmetic medicine! These are the people who are ruining your reputations! The unskilled, the unlicensed, money grubbers (and yes, I am also including lawyers here!)!

Let us also not forget that nurses and aestheticians are fighting over positions as well. There’s no certifying board for aesthetic nurses, or medical aestheticians. Here’s a funny story... when I started our medical spa with my husband years ago, I contacted both the heads of the nursing board and the cosmetology board. Since I hold both licenses I asked if I was allowed to perform a facial. I was told it’s a gray area. The nursing board said I could, in fact, perform a facial under the direct orders of a physician if the facial were deemed medically necessary. What physician do you know who will write an order for a facial? What physician wants to manage facials, and waxing, and massage, and the products which are dispensed? The cosmetology board said I could not perform a facial because the practice isn’t licensed or inspected by the board.

Huh?

With the economy the way it is, it’s no wonder everyone is jumping on the “medical spa” bandwagon! I mean, it’s like an ATM machine with no fees and no penalties. The perspective boards are all looking at each other and wondering who’s responsibility it is to be monitoring them.

The time is now upon us where legislation will take precedence, once again, on how we perform medicine and who may perform it. The powers that be will decide for us exactly if IPL is a medical device, or not. If the removal of a sunspot or tattoo can be removed by a physician, PA or nurse. Who may do cosmetic procedures, what training they must have and what certifications must be obtained prior to plucking an eyebrow (I digress, but you get my point).

Although we agree that certain treatments be performed or directly supervised by a physician, the fact is, there are many other services that aren’t deemed medical in nature. Should a physician be controlling those as well?

No current board has jurisdiction over all professions within a medical spa or laser clinic so, most likely, a new board will emerge with regulations, standards and licensing fees to add to our current practice.

It will take a few years to establish a task force and develop legislation for most states. But when all is said and done, what will arise is higher fees for service for the client, more inspectors showing up on our doorstep, higher licensing fees and insurance rates, and less control, once again, on how we treat our patients.

Are you ready for another government agency to take control of YOUR profession?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Botox, Fillers & The Right to Inject

A few months ago, I was attending a function in NJ where some physicians were in attendance. Through the course of discussion, some of us became involved in a discussion about NJ State law which prohibits nurses from injecting Botox or dermal fillers. While many of us sat there with our jaws dropped in disbelief of what we were witnessing, a plastic surgeon went into a soliloquy about why nurses shouldn’t be injectors.

There he stood on his soap box declaring his supremacy over all that was injectable as highly experienced nurses began interjecting some factoids about how nurses are specialized in IV therapies, take more time to attend training courses, and overall exhibit better patient care. It went on and on with no outcome other than shattered egos.

The truth is, many States permit nurses and PAs to inject Botox and dermal fillers as well. While many physicians may hold true to their stance that a skilled board certified dermatologist or plastic surgeon should be doing the injections, what truly matters is the skill, experience and knowledge of the injector. My point is, there are as many physicians out there who should not be doing injectables as there are nurses.

While Botox has had as many horror stories as, say, laser hair removal or lipodissolve, the truth is (if you care to do some research) that the majority of the issues with Botox were due to the fact that they were administered by either non-licensed or untrained personnel such as estheticians. In regards to nurse injectors, many of the State laws declare they can perform the injections under the direct supervision of a physician who has performed the initial examination of the patient and has written orders for it.

The initials after a person’s name should not be the deciding factor when clients choose a practitioner to inject their Botox or fillers. What is important is excellent knowledge of facial muscle anatomy, training, certification, education in the latest techniques, and hands-on experience.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Medical Spa Estheticians: Charting (or not charting) Your Termination Notice

Many aestheticians coming from the day spa industry into the medical spa environment have to learn a whole new way of documentation as a client now transforms into a patient.

Aestheticians who are used to time and date stamping treatments with occasional side or progress notes, now are expected to chart everything they say and do during a patient’s treatment. Along with charting comes treatment consent forms, HIPPA Forms, photography consent forms, payment agreement forms, anatomical charting forms, etc.

Anyone who has contact with a patient, in immediate regards to their treatments, should be charting everything from follow-up phone calls, to letters mailed, to topicals used and the patient’s response, to laser settings and the patient’s response, patch tests, follow up appointments, and patient’s tolerances to therapies.

The once client file has now transformed into a medical record by all standards which could stand up in a court of law. Some aestheticians I have spoken with have not learned the art of charting and feel they should not be required to do so.

Why is it so important you ask? Unfortunately, there have been more horror stories hitting the media than stories of healing and hope, especially when it comes to therapies that involve lasers. These unfortunate circumstances are a catalyst of change to laser laws across the U.S. Whether the MD is on site or off, they (along with the therapist) can be held liable for any legal implications filed by a patient at the hands of a clinician or aesthetician.

Harsh as it may seem, and it has even happened to our practice, even the most skilled and brilliant aesthetician could be terminated if they refuse to properly chart a patient’s care. Our rule of thumb is... if you didn’t chart it, it didn’t happen.

I’m interested to know what your facility’s requirements are for charting, and what implications can arise if you fail to comply?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Do you make a difference?

I’m very excited to be blogging for Medical Spa MD, a site I turn to to keep a pulse on what’s happening across America in the wonderful business that is aesthetic medicine! Where else on the web can you find such an open and informative forum to share, help and learn?

I found myself getting tunnel vision, only considering what’s happening in my immediately demographic marketplace and began to wonder how aesthetic practices differ in other States. We all know we share the same downfalls of the economy, but do we have similar therapies, marketing strategies, and products/services? Is there something new on the horizon that has us all excited, or could change the scope of our practice as we now know it?

Like most of you, I hear about new and innovative products and modalities coming into the arena at trade shows or from sales reps. What usually lacks is the experience the professional public has had with these “show stoppers”.

I read content on this site as a nurse, a marketer, a medical spa owner, an employer, all while keeping my mind open as patient. While the discussions between physicians are highly informative and educational, my desire is to review subject matter for ancillary personnel... the nurses, the aestheticians, the medical aestheticians, and general support staff.

Other than their education, experience and skills, we are the foundation on which physicians build their practices and trust in us to help them and the practice thrive and our therapies be safe and efficacious for our patients.

In this blog, we’ll take a look at current issues and everyday concerns such as new laws, therapies, products, office procedures and policies, and marketing strategies. As support staff members, we should feel a sense of ownership and pride in what we have chosen to do in our profession.

It will begin here... as casual thoughts and occasional epiphanies between colleagues. So, I must ask you... how are you making a difference?

Paula D. Young RN - Newest writer for Medical Spa MD

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.