Medical Spa Estheticians: Learning how to perform laser hair removal

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It's the number 1 laser procedure performed by aestheticians in medical spas across the U.S. - Laser Hair Removal. If you're old schooled, 10 to 1 no one ever taught you about laser hair removal procedures.

With facial and chemical peel services on the downfall these days, I've received many emails from aestheticians wondering where to get trained in laser hair reduction so they can secure a position within a medical spa, or just advance their career. Aestheticians are lucky in my area, they have a wonderful beauty academy right at their fingertips where they can get an advanced education in aesthetic services (if they want to go back to school). Their training manual is the Medical Spa Advanced IPL & Training Course, available through Medical Spa MD.

In the Laser Hair Reduction Chapter, you will learn about the anatomy and growth phases of a hair follicle from the anagen phase to the telogen phase and what the significance is of those stages during treatments. You will also learn the differences between and Nd:YAG, Alexandrite, IPL and diode lasers for hair reduction. Other important pearls are skin typing, ethnicity responses to therapy, topical anesthetics and using them safely, patch testing, and information about how various body areas respond to treatment.

If you're looking for a way to get the theory behind laser treatments, then take a look at the Medical Spa Advanced IPL & Training Course.

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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Fluorouracil for Wrinkles

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If you pick up most women's magazines in the waiting room of many offices, usually what you see are endless fashion ads and fragrance samples. One magazine, Allure, seems to delve into the beauty industry far deeper than cosmetics and moisturizers with their investigative reports on scientific research. Kudos to you, Allure.

As a dermatology nurse, I came across a brief interesting article in the December issue of Allure entitled "Fast Anti-ager". For those of you who do not read Allure, let me post the entire article:

Doctors have long noticed that patients who use the prescription cream fluorouracil, a treatment for precancerous skin lesions, "tend to look really good afterward," says Dana L. Sachs, an associate professor of dermatology at the University of Michigan, Ann Arbor. Now a study led by Sachs has documented the cream's anti-aging effects. Patients who used it on their faces twice daily for two weeks had decreases in wrinkles, uneven skin tone, and brown spots, as well as in precancers. The drug injures the skin, triggering a beneficial repair response; redness can last for a few weeks. Sachs says studies are needed to assess fluorouracil's cosmetic use in people with relatively mild sun damage.

Perhaps a study worth following.

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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Career Advancement for Medical Estheticians

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Awhile back I posted an aesthetician position on a local job search website. In my requirements, I had stated that only those aestheticians who have been trained in the proper use of laser technology should apply. I must have received over 100 resumes with barely a few who have ever laid their hands on a laser or even observed any procedures.

I selected a few resumes who I felt had years of experience and; therefore, would know the basic concepts of how skin reacts to laser light, Fitzpatick Skin Typing Scale, etc. I was surprised at how many of them had no idea how to answer what I was asking them.

It's obvious there are many skilled aestheticians out there seeking employment, or desiring to advance their career. I would highly suggest the Advanced IPL & Laser Training Course for Estheticians & Medical Spa Laser Technicians.

Advanced IPL & Laser Training Course is much more than knowing what the difference is between 532nm and 2940nm of light; or how different wavelengths affect blood, pigment and water; or even how laser light affects the stem cells of a hair shaft during the anagen growth phase. It's about broadening your knowledge of the aesthetic field, becoming a more valuable member to a medical aesthetic team, increasing your revenue by commission and upselling with your knowledge, and benefiting your patient by being able to explain various treatment options for them (some performed by you and other treatments by the physician). Even though you may not perform every treatment in a medical spa, such as injectable procedures or laser skin resurfacing, your knowledge of those procedures is very important in the patient advocate and educational process.

Even if you have no hands on training at this point, the Advanced IPL & Laser Training Course for Estheticians & Medical Spa Laser Technicians will lay down the foundation you need to secure a position in a medical spa. If one of the candidates had any understanding of some of the principles of laser technology, I would have brought them in for a personal interview with the physician. Hands on training is the easy part, the hard part is the theory behind laser technology.

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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The Hidden Dangers of Beauty

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Normally, I barely listen to the radio when driving in my car, but today on the John Tesh Radio Show (Sunday) my ears perked up when he started to discuss the hidden "dangers" of young girls using makeup too early. Dangers in makeup? Really?

The broadcast was entitled "The Ugly Truth About Young Girls Wearing Makeup". The line that grabbed my attention was "the sooner your daughter starts wearing makeup, the sooner it might kill her!" This was a quote coming from Stacy Malkan, a cosmetic expert who wrote the book Not Just A Pretty Face: The Ugly Side of the Beauty Industry. According to the John Tesh website, Malkan states "by the time most North American girls become teenagers, many have a daily make-up ritual that includes lipstick, mascara, eyeliner, nail polish and perfume, not to mention skin lotion, shampoo, conditioner, and hair color treatments." She goes on to say "in fact, experts estimate that a typical young girl now walks around with at least a dozen layers of beauty products on her body! As the makeup layers add up, so does her exposure to dangerous chemicals, and that’s very bad news for a young girl’s health."

Apparently the culprits are chronic exposure to parabens and phthalates which have been found to disrupt hormone levels during adolescent years which may result in early puberty. Malkin continues to state "one study found that HALF [sic] of all North American girls now begin to show signs of breast development by the age of 10 – which is more than two years sooner than females from our grandmother’s generation. Other studies link those unusual hormone levels to a higher depression rate among young girls, and a higher risk for breast cancer! That’s why experts recommend women of all ages find out exactly what chemicals go into their makeup."

There is a website suggested for reference to verify the ingredients in certain beauty products and cosmetics and it is called the Skin Deep Cosmetic Safety Database. I was instantly intrigued and raced to my Mac when I got home to give it a try! Here's how my products scored:

(Scale: 0-2=Low hazard; 3-6 Moderate Hazard; 7-10 High Hazard).

  • Cleanser: 3 (moderate hazard) 
  • Toner: 7 (high hazard) 
  • Moisturizer: 5 (moderate hazard) 
  • Eye Cream: 6 (moderate hazard) 
  • Lip Cream: 7 (high hazard) 
  • SPF 30: 7 (high hazard) 
  • Concealer: 4 (moderate hazard) 
  • Foundation Primer: 5 (moderate hazard) 
  • Foundation: 9 (high hazard) 
  • Loose Powder: 5 (moderate hazard) 
  • Blush: 7 (high hazard) 
  • Bronzing Powder: 8 (high hazard) 
  • Eyeshadow: 7 (high hazard) 
  • Mascara: 8 (high hazard) 
  • Lipstick 6: (moderate hazard) 

My gosh, I'm a walking carcinogen!!! Like most women, I use an array of products, from medical grade like Obagi, spa grade like SkinCeuticals, high end department stores like Merle Norman, Estee' Lauder and Laura Mercier, right down to drug store brands like Maybelline. It seems no company's products were completely safe. And, makeup is just the beginning for young girls!

More and more young girls are taking their skin care regimens to the next level by having microdermabrasion treatments and chemical peels, with some escalating to laser and injectable therapies. Putting aside the various protocols for acneic adolescents, there has actually been a rise in the U.S. of young girls undergoing laser hair removal, photo facials, dermal filler procedures, even laser lipolysis. Where do we draw the line as clinicians? 21? 18? 16 with parental consent? I know in our medical spa we have been approached by parents inquiring as to what our policy is for treating adolescents for non-medical related conditions. The number one request is laser hair removal for ethic skin types predominately for excess facial hair. Many clinicians feel it is a low-risk procedure which can lift a child's self-esteem. Some clinicians disagree and feel a child is much too young to be exposed to laser therapies.

I'm not a laser expert and am uncertain as to if many aesthetic equipment manufacturers have performed clinical trials on adolescents for laser procedures (other than port wine stains). I'm more apt to believe the answer to this questions will become clearer as the years go on and by remembering the first rule is to "do no harm".

That, and to throw away your teenager's makeup!

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 MD: End of the Road for Evolence

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I must say I am a little disappointed in my former company of employment, but on November 3rd Johnson & Johnson, Inc. announced that they will no longer be manufacturing or marketing Evolencedermal filler in the United States just a year after they received their FDA approval.

Ortho Dermatologics porcine derived collagen filler was gaining in popularity with many clinicians across the U.S. praising the product for its ease of injection and smoothness in appearance and feel. Although few in number, the main complaint of the product from a consumer standpoint was that they wished it lasted longer. However, many went on to say the look and feel of the results far outweighed its lasting effects.

Johnson & Johnson, Inc. has not stated a definite reason for why the product is being pulled from the U.S. market. A statement on their website reads:

"On November 3, 2009, we announced our intention to discontinue the manufacture and marketing of EVOLENCE®products. Patients and medical professionals who may currently be using EVOLENCE® products can be assured that they remain effective for the approved indications with a favorable safety profile. EVOLENCE® products will continue to be supported for medical inquiries and adverse event reporting, in accordance with regulatory requirements."

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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Young Medical Spa: Further Developing the Breasts

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When the first laser lipolysis device was approved by the FDA it started a whole new revolution in the medical spa industry.

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?

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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Your Medical Spas Commitment to Your Community

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There are a lot of charitable organizations that routinely ask our medical spa for support whether it's a listing in their event program, a donation of a gift card or gift basket, or all out sponsorship of a fund raising event.

If you have a charitable heart, it's hard to choose which causes you can afford to support and which ones you cannot. Like all businesses in today's economy, medical spas have their challenges right now in keeping their businesses in the black. While making the commitment to keeping your employees and bills paid, I'm sure most of you feel an obligation to have a commitment to your community. So, instead of offering large donations to a cause, what are some other ways you can show your support for your community?

Go for a Walk! October is Breast Cancer Awareness Month and while we may not be making a large charitable donation, my entire staff bonded together yesterday to walk in a 5K Breast Cancer Awareness Walk. Wearing matching outfits and showing the sponsorship of our medical spa, my staff has made me so proud that they have given up their Saturday to walk in the freezing rain for a wonderful cause! I'm so very proud of you girls!

Put it in a Bag! At the beginning of the year I placed a large order for some pretty awesome gym rated duffle bags with lots of pockets and compartments and, of course, our logo embroidered on both sides. When someone calls for a quick donation, it's easy to fill one of these bags with some tissue paper, a Gift Card, our Menu of Services, brochures, and some little samples provided by our reps like cleansers and moisturizers.

Strategic Gifts! A campaign we really liked this year was SpaFinder's Melanoma Bracelet during the month of May for Melanoma Awareness month. In addition to our eNewsletter and Blog to educate our clients on the early detection of melanomas, we purchased these "REFLECT" bracelets from SpaFinder in bulk and handed them out to every skin consultation we performed in our office during the month of May. This special bracelet changes color when exposed to harmful UV rays.

See RED! Have your staff members wear the color red on the American Heart Association's National Wear Red Day during the month of February! We even handed out red foiled chocolate hearts to our clients and offered a special discount coupon to any client who came into our office wearing red that day! This all was advertised ahead of time on our website and eNewsletter.

While these are just a few ways you can show your willingness to get involved, I'm sure you get the idea of how easy it is to not spend a fortune and still make a difference! I encourage you to post any promotions/ideas you have to help others in our industry help show they are a part of their communities!

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

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Advanced Aesthetics Course: Understanding Injectables

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Injectable products are an important contributing factor to your clinic's financial success. With new products entering the market like Dysport and Evolence, and other exiting like ArteFill, it is important that your staff be knowledgeable of the products used in injectable procedures.

Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for , especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

Medical estheticians have the most “face time” with clients, examining it with magnifying lenses, treating it with exfolliants, moisturizers, galvanic current, high frequency, various acids, etc. They understand the realm of fine lines and wrinkles and know what can be alleviated with topical treatments such as facials, peels, microdermabrasion and laser resurfacing, and what cannot.

I cannot tell you how many patients call or come into our office with no knowledge of the difference between paralyzing agents such as Botox and Dysport, and dermal fillers. We take it for granted that we know the difference, but injectable products can be very confusing to the lay person. Because the aesthetician works with the client’s skin, they should be well versed in the differences in the two categories of injectables and the products that lie within. Estheticians become your most powerful education source for your clients which ultimately leads to an upsell for them (with possible commission).

Many people think all fillers products are the same, nor do they care to understand the difference between hyaluronic acid or calcium hydroxylapetite. All they truly care about is “how long will it last” and will the “results look fake”. Only with proper education can the medical esthetician effectively and intelligently discuss the differences in the filler products, educate the patient about the effects and lasting results, and help lead the patient to the right product, or combination of products, for their expected outcome.

This information in this chapter is very important for your front desk/phone people as well!

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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The U.T. Zerona low level laser Study... A Pig is NOT Just a Pig!

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I'd like to issue a rebuttal critique, if I may, regarding the University of Texas study on the ZERONA low level laser entitled the "Effect of Low-Level Laser Therapy on Abdominal Adipocytes before Lipoplasty Procedures".

I know there has been a tremendous amount of skepticism regarding this technology and I just want to share with you my thoughts, as fellow colleagues. If anything, it is continuing the valuable discussions we have here in our group that compels me to write this.

If you are not familiar with this study, it involved the use of a swine model. This is an area I am most proficient with. I was a veterinary technician before I became a nurse. I used to run the "pig labs" for clinical research and physician training for a major medical device company and have much experience in 510K clinical trials and was well regarded as a swine expert. I tell you my background only to hope you find validity in my critique.

My biggest problem is with the 300 lb.Yucatan pigs they used in the study. There are many categories of swine for use in experimental procedures and research with some being favored for one reason or another. The more proper Yucatan pig to use for any transdermal study is a Yucatan micro-pig (about 30 pounds) which has a skin thickness similar to that of human skin, and they are relatively hairless. This breed of pig was specifically bred in the swine labs at the Colorado State University in 1978.

I'm not certain as to why these researchers decided to use 300 pound Yucatan pigs with their incredibly thick skin and coarse hair. Perhaps they thought a pig was a pig. Perhaps they wanted to see if the Erchonia laser could penetrate steel... perhaps they know something about research pigs I don't My point is, there is more to this study than what seems to be "obvious" to some.

Here are two famous references I can direct you to to validate my statement that they used an inappropriate swine model:

1. Comparisons of in Vitro Nitroglycerine (TNG) Flux Across Yucatan Pig, Hairless Mouse, and Human Skins. Journal of Pharmaceutical Research. Springer Netherlands, publisher. ISSN: 0724-8741, Vol 7, Number 6. June 1990.

2. Fujii M, Yamanouchi S, Hori N, Iwanaga N, Kawaguchi N, Matsumoto M. Evaluation of Yucatan micropig skin for use as an in vitro model for skin permeation study. Biol Pharm Bull 1997 Mar; 20(3):249-54.

My other problems with the study include:

1. The pig underwent one ZERONA session, not the standard protocol of 6 (3 a week for 2 weeks).
2. No flushing niacin or any substantial vasodilator was used to facilitate fat transferral out of the interstitial space.
3. The Erchonia lasers were positioned 12 inches above the skin when they shouldn't be any further away than 6 inches.
4. The pig was immediately euthanized on the operating table after the single treatment. How are the adipocytes supposed to render any changes in morphology if the host is dead?
Clinical studies are always under scrutiny and this study is no exception. I'd bet a guess that you will start seeing more positive reviews of the ZERONA low level laser in the months to come. And, I base this on the sheer science of the technology. Only time and true trials of the device will tell.

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: It's the Cook's Fault... Not the Stove!

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Throughout Medical Spa MD you can read posts from dissatisfied patients on their procedures and disgruntled employees on their previous place of employment.

The most recent post I read tonight was from "Warning Others", a former employee of American Laser Centers, and there seems to be quite a few on that chain of medspas! These types of reviews can be found anywhere on the web including the most notorious site, RealSelf, who banishes all practitioners not deemed worthy of performing aesthetic procedures (i.e., non plastics and non derms), and  Plasmetic Forums, to mention a few.

In the American Laser Clinc employee's post, they made one statement that really should be expanded upon and that was the comment that "VelaShape does not work".  They went on to say that "all (of) the customers were very unhappy with their results - even after the recommended 6 treatments". In the same paragraph, W.O. stated they "didn't see any customers who were completely hair free either. Yes, some did see hair reduction, but no complete hair loss. I also saw my co-worker burn a lot of customers (and the clinic manager wouldn't report it!)".

This really concerns me and it should you too if you are a practice owner or director.

Equipment in the hands of a practitioner is only as good as the practitioner is trained to be. It doesn't matter if it's a laser lipo unit or microdermabrasion machine. I know, for a fact (as it has happened in my own practice) that the VelaShape does work. Really well, actually. I've seen it with the technicians who studied the technology and worked hard at obtaining positive results for their patients. We had to fire an employee who didn't take the treatment seriously and didn't strive to be the best at what she did. Not only does your technician need to be trained and enthusiastic, they also need to be monitored by YOU (the owner or director). Patient results need to be sampled and individual charts reviewed to assess the technician's skill and clinical outcomes.

Take, for example, our VelaShape technician. She is a massage therapist knowledgeable of musculature anatomy, and possesses strong hand techniques required to perform an optimal treatment. She is responsible for maintenance on the unit giving her a sense of ownership of what she does. She is also the liaison between the company, the rep, and our medical spa. Everything goes through her (with me being cc'd of course). On top of all that, I review her patients from time to time even treating them myself to make sure her techniques are where I feel they should be and patient satisfaction is high. Ownership and teamwork make VelaShape successful in our practice.

The same philosophy is even more true with laser hair reduction/removal. Many estheticians are afraid of burns, so they step back on laser settings sometimes not even following the skin typing requirements and standard parameters. While they may feel "safe" from a burn, they aren't treating the patient at the therapeutic level for optimal results. In the end the patient won't be happy either way, whether they were burned, or whether they obtained poor results. Bottom line is, it looks bad for you.

If you're not doing so already, any technician handling any device should be constantly monitored and retrained to ensure they are operating the devices as safely and efficaciously as possible. They should attend company sponsored courses or the rep should be brought back in to ensure policies and procedures have not changed, or treatment modalities wavered.

If your technicians can't comprehend the fundamentals and technology of the procedures they perform and the repercussions that could arise should they operate equipment improperly, perhaps they would benefit from the materials soon to be offered here on MedicalSpaMD, The Medical Spa Aesthetics Training Course and Study Guide or an advanced aesthetics course offered in a beauty academy.

One final comment, any technician who feels they are not being properly trained and that their clients are being cheated out of a good result for their procedure should walk like W.O. did. 

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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Care Credit - No Longer Practicing Medicine

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I was included in an email from a fellow MAPA member yesterday with some urgency regarding Care Credit ceasing to do service with their medical spa.

This physician was to the understanding that Care Credit is suspending its services to any practitioner who is not a plastic surgeon, dermatologist, cosmetic dentist or veterinarian.

Immediately my stomach got tied up in knots as I thought “here we go again... another RealSelf debacle!”. I decided to get that facts for myself being that our practice is a non-plastic, non-derm facility.

During the call I found out that this rumor is partially true in the fact that Care Credit is suspending services to facilities that:

  1. Do not have a physician on site approximately 60-70% of the time.

  2. To physicians who are primarily medical directors that mostly travel between facilities.

  3. To practices that do not have at least 60-70% of their services being cosmetic in nature.

  4. Practices that perform medical care, critical care, fertility services, long term care, pain management and weight loss services that occupy the majority of services in their practice.

  5. To physicians who do not perform at least 60-70% of those cosmetic procedures themselves.

In talking with the customer service rep, she said they have made this decision to "consolidate their strategic image" and they are not “singling out” any specific specialty. She said their main decision to decline some accounts is because they don't want to stand in the way of a medical patient receiving experimental care, or a procedure that an insurance company won’t pay for that is considered medical in nature. Although not deemed “medical” in nature, per se, fertility clinics are also being denied services. In discussing the board certification requirements, I could not get a clear and decisive answer other than physicians need to be board certified. Period.

She also told me that she could tell by our account number (the 4 digits in the center) that our account with them was initially set up as a cosmetic practice and not internal medicine. Those identifying numbers is what triggered letters to go out to certain practices and not others.

She went on to say that if anyone feels they do 60% or more cosmetic services, and the doctor is on site and performs at least 60 % of those services, they can call to dispute.

So, to clear things up for those of you who are uncertain as to your status, I asked for a copy of the letter that went out and I think it’s pretty self-explanatory. Here’s the crucial part of the letter:

“GE Money Bank continuously reviews our portfolio and lending criteria to anticipate and respond to market conditions, consumer needs, and strategic fit.

Upon review of our portfolio, we have determined that we will be limiting our lending partnerships in the cosmetic market to Board Certified Plastic Surgeons, Facial Plastic Surgeons, Dermatologists, and a small number of other Board Certified specialties performing cosmetic surgery.”

I have also heard rumors that Chase Health Advance is, or will be, taking similar action. My closing thought is, if you didn’t get a letter, then chances are you have not been rejected.

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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MedSpa Reality TV... Unbelievable!

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Hard to believe, but we should’ve seen it coming... a reality show about a medical spa has hit the airwaves. Last night, the Oxygen channel debuted a new reality series called “Addicted to Beauty”. It follows the daily antics of “Changes Plastic Surgery and Spa” in La Jolla, CA.

All I have to say is, after watching this ridiculous show you’ll never complain about your staff again! And, if this is what medical spas are like in La Jolla, am I ever glad I’m on the East Coast!

The show centers around Dianne in the midst of a divorce who joined forces with Dr. Gilbert Lee, plastic surgeon. Reminiscent of the Cat Woman, Dianne thinks her staff is her family, which explains the total lack of control, disrespect and dysfunctionality.

Her Spa Director, Shannyn, is equally as disfigured from excessive aesthetic procedures. I didn’t see much management of the staff or spa during the show, but hey, just watching her try to portray an executive with some management experience was entertainment enough.

Gary and Ronnie’s responsibilities have yet to be determined. Between crying fits and backstabbing I never quite got the gist of what their job descriptions actually were. Only Natasha, Dianne’s assistant, actually did some work as she is aspiring one day to own her own medical spa. I actually never did see any "medical spa" procedures or staff members other than Dr. Lee's nurse.

Poor Dr. Lee. He seems like such a talented plastic surgeon with a wonderful personality to boot, to be hooked up with such drama and incompetence with the circus staff of the medical spa.

Showing the worst possible side of a medical spa, I’m not sure if a show like this will help or hurt the our industry, but I can honestly say, it definitely was entertaining!

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? Restylane? Juvederm? Lose the wrinkles & get a job.

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The unemployment rate for the month of June for the U.S. was hovering around 9.7% according to the U.S. Bureau of Labor and Statistics. Some of my own family members have found themselves out of work after being in management positions for years only to be replaced by younger, cheaper laborers. Skilled individuals are being turned down for new job opportunities, but for what reasons?

People I know who are out of work state that they are told they are "over qualified" for the open position, or their salary requirements are "too high" for the company to met during these struggling economic times. Okay. I understand that.

Recently, our medical spa was interviewed by a local newspaper who was writing an article about older unemployed people turning to cosmetic services in order to freshen their image to compete with younger job candidates. The article stated that job competition is fierce and while candidates are polishing up their resumes, they're seeking aesthetic services to polish up their bodies and faces. Other physicians interviewed for this article stated that people ranging from 40 years old and up, predominately women, are looking to have these procedures performed.

When we were approached about this article I was dumbfounded for I truly did not know of any of our clients who came in saying, "hey, can I get some Botox and filers to erase these lines on my face to compete for this sales job against this 25 year old right out of college? And, why your at it, can you get rid of these flappy arms and turkey neck I have?" And, believe it or not, we were approached for our comments on the same topic for a major magazine.

Our medical spa is close to Philadelphia and New York City and we are surrounded by thriving companies like Merck, Johnson & Johnson, Olympus, etc. so we're not in a rural area by any means, and I still wasn't aware that older job candidates were racing to have these procedures performed to increase their chances of landing a new job. I have seen an increase in new clients because of new technologies and products we have added which weren't available a few years ago.

I'm very interested in knowing if your practice has seen an increase of clients undergoing cosmetic procedures to compete for a job and, if so, what procedures are they seeking to have performed? Are they predominately male or female and what is their approximate age range? If this truly is a real "situation" perhaps we're missing a marketing opportunity to offer these individuals discounted bundled packages to assist them with their quest.

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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Non-Invasive Fat Melting Devices: Sail or Sink?

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There’s a lot of buzz about the new wave of non-invasive fat melting devices like Zerona™ (635nm low level laser), Lipo-Ex™ (radio frequency) and UltraShape® (selective focused ultrasound) who all lack the illustrious FDA clearance desperately needed to make a huge impact in the body sculpting arena.

Sure they possess FDA clearances for safety, but not yet efficacy in the key category of actual fat reduction. What’s the FDA’s hang up? Apparently it has to do with fat metabolism. Specifically, the FDA wants to know what happens to the fat that is expelled from the liposome after treatment, it’s ingestion by macrophages, the transportation to the lymphatic system, and the final excretion by the kidneys. The FDA wants to ensure no harm will come to a patient by this natural process of foreign body elimination. They also want to prove they work as a stand-alone therapy.

I’ve talked with many physicians at ASLMS and The Aesthetic Show and have read posted discussions by fellow MAPA members like, Dr. Lornell Hansen who is extremely proficient in the development of lasers in the U.S. and is highly regarded for his opinions. If I may quote Dr. Hansen, he states every time he asks physicians who have used, specifically the Zerona™ by Erchonia, over the last few clinical trial years if the device actually works, the answer he receives is they “think it does”. For many physicians that answer doesn’t quite cut the mustard when you're thinking of investing time, money and your reputation on a device. On the other hand, if the technology is proven to be clinically advantageous for your patients, and they finally do receive the FDA’s approval in the next few months as all companies are claiming, are you willing to “miss the boat” and sit idly by on the shore watching everyone else sail into a sea of opportunity? Or, will you get into the boat too early and risk having it sink? It’s a gamble and timing is everything.

Well, our medical spa has thought long and hard on this technology and we have come to the conclusion that if the device is positioned in the right practice and for the right patient, it can be advantageous for both our practice and the patient. Many patients we see during complimentary consultations don’t want to have a minimally invasive surgical procedures, or the multiple injections of lipodissolve. They diet and exercise regularly, but can’t seem to lose those pockets of fat that seem impenetrable by their current regimen. Our practice offers SmartLipo™, SlimLipo™, VASER® Lipo, lipodissolve and VelaShape™. Body contouring is 80% of what we do. We believe this device has a place in our practice either before or after laser lipo, or combined with the lymphatic drainage abilities of the VelaShape™. Of course, with all body contouring procedures, optimal patient selection is a must for success.

Our decision was influenced in the faith and belief in technology and also the fact that the Zerona™, unlike the UltraShape® and Lipo-Ex™, is at least FDA market cleared for laser assisted liposuction. And just think, a few years ago even laser lipolysis was scoffed at. And, who would’ve even dreamed that fractional technology would exists and prove to be beneficial? Technology will continue to advance. Sometimes it works they way you hoped it would, other times your dreams fall a little short.

So, we are very excited to take the leap of faith into the Zerona™ low level laser and look forward to only positive results for our patients. If it works like we trust it will, we all win and score one more for technology! If it falls short, the worst that could happen is that the technology will need a little more “tweaking” and we’ll sail out boat back to shore.

We’ll keep you all posted on our travels.

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 Marketing: Calling All Clients!

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While attendance was down at THE Aesthetic Showthis year in Las Vegas, the enthusiasm for practice rejuvenation was high. Every lecturer mentioned, in one way or another, the hardships of practicing aesthetic medicine in this economic recession. Speakers delivered suggestions focusing on how to grow your practice with either an increase in marketing endeavors, a decrease in operation costs, or addition of new services.

Most clinicians in attendance were looking for the next great technology to add to their practice to bring in new patients. I think a sobering message, at least for me, was Dr. Stephen Mulholland’s lunchtime motivational speech on how to cut the fat in your practice and how to capitalize on internal marketing of your existing patient population which is something we’re all probably not doing to the fullest of our potential.

His point was right on when he said we spend more time and money trying to solicit new patients that we aren’t capitalizing on the patients we already have. While we may be sending our patients birthday cards with incentive coupons, or monthly newsletters, how many of you are conducting an active outbound marketing campaign? Botox follow-up reminder calls, “thank you for the referral” call, how about “we know you've tried filler A in the past and we have filler B on special this month”?

If your practice management software is not engineered to be able to pull out these clients for follow-up calls, it’s time to change software programs. Now more than ever you need to be able to query on a certain group of patients who are ready for a follow-up treatment and have not yet scheduled their appointment. Dr. Mulholland’s point was that you have already gained the trust of that client so why let them slip through your fingertips? Current clients should be treated as VIPs as their positive experiences are going to bring in new clients via “word of mouth”.

So, if you’re experiencing more downtime in your practice, now is the time to appoint a staff member to begin an active “client rejuvenation” campaign.

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 Special: Botox, Hemorrhoids & White Teeth

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As patients are tightening their belts and technology is delivering newer procedures that require less time off of work and less money out of a patient’s pocket, more cost-effective solutions are overtaking the once considered gold standard practices, such as liposuction and facelifts.

We’re all aware of the turf wars among plastic surgeons and dermatologists versus the “non-cores”. But a new turf war is spreading into other areas of what is deemed cosmetic practices. As dentists begin using Botox to subsidize their practice’s income, “non-dentists” are dipping into their area of teeth whitening.

Teeth whitening franchises can be seen available at almost every aesthetic trade show. Not only are other physicians adding teeth whitening to their practices, but day spas and beauty salons are also getting into the action!

While dentists are claiming that teeth whitening practices require specialized training in the anatomy of the tooth, trade show vendors will tell you that’s nonsense. They state it is not a dental procedure, but a cosmetic procedure which are more commonly preferred in salons and spas. At a trade show, I was told by a booth vendor that my receptionist could perform the teeth whitening with no medical supervision necessary.

Spas are advertising teeth whitening as “why have it done in a sterile office when you can relax in a soothing spa setting?”. Hmmm. In fact, they boast “why not have other spa services performed at the same time” so they can “take care of all of your aesthetic needs in just one visit”? Here’s a quote I found online from one day spa offering teeth whitening: “quell your fears and anxieties by relaxing in a massage chair, listening to soothing music or enjoying the aromas of scented oils wafting around the rooms. You might even hear the trickling of water from a fountain”.

Are you kidding me? Teeth whitening is hardly a procedure to get anxious about. In fact, the procedures take a maximum of 15 minutes to perform. By the time the aromas start wafting, you’re done!

Is this a procedure that is necessary for financial survival of a medical spa or laser clinic? Where will it end? Will we also be performing hemorrhoidectomies which only require a local anesthetic? Or, perhaps removal of an ingrown toenail?

Call me a cynical nurse, but I say leave the Botox to the cosmetic physicians, the hemorrhoids to the proctologists, the toenails to the podiatrists, and the teeth whitening to the dentists.

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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