Botax: Taxes on Botox and plastic surgery?

The medical spa and plastic surgery community is in an uproar over some proposed legislation that could make a trip to the plastic surgeon or a Botox injection at the medical spa more expensive.

People are calling it the Botax. It's a 5 percent tax on elective procedures such as Botox, Juvederm, Restylane, laser hair removal, facelifts, breast augmentation and other nips and tucks that lawmakers are hoping will help fund the nearly $1 trillion health care plan.

The bill says the tax would not apply to surgeries to fix a deformity either from birth, accident, or disease. It would apply to procedures like face lifts, liposuction, cosmetic implants and teeth whitening.

But as Dr. Paula Hicks points out sometimes cosmetic surgeries have very medical purposes.

"Certainly breast reduction surgery is a very good surgery for a lot of women and a lot of them will get denied by the insurance company as cosmetic surgery," said Dr. Hicks of the Ave Medical Laser Spa and Laser Clinic.

Under the proposal, Dr. Hicks says an eyelid tuck, which can help with vision, would cost an extra $100 in taxes on top of the $2,000 price tag for the procedure.

She says that could be a big hit to her business since most of her clients are not wealthy.

"Most of these procedures are not done on people that are rich and have endless amounts of money, it's middle class working women that would be targeted with this tax and it's really not fair."

According to the American Society of Plastic Surgeons 86 percent of cosmetic surgery patients are women. Sixty percent of them have annual incomes between $30,000 and $90,000.

The tax, if approved, would raise $6 billion over 10 years.

Allergan, which sells Botox, took a civil rights angle: The tax “discriminates against women,” the company said in a statement. Some 86% of cosmetic surgery patients are working women ages 35-50, with an average annual income of $55,000 per year, according to Allergan.

“What’s next? Are we going to tax people who color their hair?” the CEO of Medicis, a drug company that sells fillers, told Dow Jones Newswires.

The American Academy of Cosmetic Surgery, which is fighting the provision, says “a large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures.”

A spokesman for the 2,500-member group said they were surprised to see the provision in the Senate bill this week, because it had already surfaced and sank in July. The tax is not in the House bill.

The tax is on elective procedures, and would not apply to any procedure to correct birth defects or issues arising from disease, accidents or trauma. The CBO says it would raise about $5 billion over the next decade.

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Do it yourself Botox? ABC News wants to talk to you.

Have you tried do-it yourself plastic surgery or home Botox injections?

In tough economic times, many try to cut costs, including in their beauty regimen. Despite the risks, some people have decided to skip the doctor -- and obtain and self-administer cosmetic treatments.

If you have self-injected products like Botox, Restylane, Juvederm, silicone, and other substances, 20/20 would like to hear your story.

Please fill out the form below, including information about your experience, and a producer may be in contact with you.

You can tell ABC all about it here.

The Hidden Dangers of Beauty

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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Do it yourself laser hair removal... Unhappy medical spas?

The're are a growing number of 'home laser hair removal' devices appearing on the market. This article on do it yourself laser hair removal supposes that medical spas and laser clinics are feeling the heat.

Want to get rid of some unsightly hair, but don’t want to spend the big bucks for electrolysis or a laser clinic? Now, you can buy your own laser and do it yourself.

And people are.

The growth of the at-home cosmetic-device market, which includes personal lasers, has some professionals buzzing. At an annual conference hosted by the American Society of Plastic Surgeons, Barry DiBernardo, a New Jersey surgeon, delivered a talk in Seattle about the pros and cons of the DIY market on the ASPS’s “Hot Topics” panel.

“We have to make sure that the patients are getting good, safe treatments. If they are getting good, safe treatments, then whether they are doing it at home or not, I’m not as worried,” DiBernardo told Wired.com by phone. “What I’m worried about is that they are seeing things in the Skymall on the airplane and spending hundreds of dollars, thousands of dollars on something that is not going to work or is unproven.”

New cosmetic medical devices including DIY lasers are expected to explode into a $1.3 billion market 2013, up from just $296 million in 2008, according to the analyst group Medical Insights. The growth in the market appears to be coming from light-based products that claim to either remove or grow hair on the human body. The Silk’n Hair was the first at-home laser device to be approved by the FDA, in 2006, although it didn’t come on the market until early 2008.

The laser hair removers damage the hair follicles that are in their growth phase, generally leading to some permanent reductions of body hair. DiBernardo questioned whether the lasers used in the home devices were powerful enough to get the kind of results that clinics achieve.

“In general, these devices are low-powered versions of the doctor versions. We’ve been doing hair removal since 1998, so we know that they work and how well they do,” he said. “I think these home devices have some effect, but they legally can’t have the power of what we fire at people.”

From nother nice post from Wired:

My own experience is that people looking to do it yourself home laser hair removal (or skin tightening or complexion light-based photo-therapies) are really looking to save money and are buying a device in the hope that it will work. Patients who are actually interested in laser hair removal or skin tightening are put off by these types of home remedies. I've never heard that a laser clinc or medical spa is suffering from this, but I may be wrong.

Does anyone running a medical spa or laser hair removal clinc feel differently? Is laser hair removal at a medspa moving to home laser hair remvoal that a do it yourself laser treatment?

Medical Assistant's can not inject Botox!

I've seen and head about medical estheticians, medical assistants and even front desk staff administering Botox injections.

It's not legal, as this story on the prosicution of a medical assistant clearly shows.

Betty Guerra’s monthslong nightmare is over.

The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.

“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”

Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.

Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.

The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.

“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”

Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.

After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.

Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.

However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.

The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.

Ling resigned on Friday.

Guerra, a mother of three who was a physician in her native Peru, said she has been under incredible stress since her arrest and lost her job because of the publicity surrounding her case.

“It was a nightmare. I could not even sleep or eat all this time, wondering what was going to happen.”

Still, she said she harbors no anger.

“Now, I start all over. But it’s just another experience in my life.”

Via Review Journal story.

Medical Spa Lesson: The least recommend way for handling your medical spa PR problems.

Note: The identities that were in this post have been changed but the events are all as described.

A Medical Spa chain is not happy with what someone else has posted about them in the community forums of this site.

The negative comments are directed at one of the management team. I became aware of this medical spas concerns a few days ago after I received a string of emails from the medspa chain's 'CS Manager'. (Im guessing that CS is short for customer service.)

I can certainly understand why this medical spa is unhappy. Evidently the individual named in the comments was previously part of a failed franchise called Skin Nuvo and was one of three Skin Suvo operating officers who was sued by the SEC for 'Swindling investors of $11 million'. However, charges against the individual in question were dropped.

Here's an excerpt on the Skin Nuvo suit from the San Francisco Chronicle article:

Three men, including a Concord resident, were sued by the Securities and Exchange Commission on Wednesday on charges that they swindled more than $11 million from investors in a skin-care business that later filed for bankruptcy.

..."Skin Nuvo was projecting a glamorous image with their stores in very flashy and high-end malls, but beneath the surface, the company was in deep financial trouble," said Michael Dicke, an SEC supervising attorney.

Skin Nuvo, based in Henderson, has since filed for bankruptcy. During the alleged fraud from 2002 to 2004, the company's Bay Area stores -- which sold skin care and hair removal products -- were located in shopping malls in San Francisco, San Jose, Richmond, Concord, Corte Madera and Walnut Creek.

The SEC suit seeks to bar the men against any future violations of securities laws, a civil monetary penalty and the recovery of any ill-gotten gains.

So here's some of the emails that I received, and my response, over the course of the next three or four days. They start with an email from S.H. the CS (Customer Service?) Manager.

First email: S.H. of Nu U

Subject: Slanderous blog agiainst N.V./___ Medspa
Message: I need to speak with someone ASAP re: several slanderous remarks that have been made on your forum against N.V., owner of _____ Medspa.
Please contact me at 702-xxx-xxxx to discuss.

Thank you,
S.H.
CS Manager

My same-day response to S.H.:

Hello S,
What can I do for you?

S.H. want's to talk immediately. He's entirely too irate to just communicate that a comment may have gone over the line and violated Medical Spa MD's own terms. No, S.H. want's to talk. Now. Here's the next two emails:

Is it possible to call you?  Too much to put in an email.

S.H.

Jeff – there is a blog on your website re: N.V., owner of _____ Medspa.  The blog is dated 3/4/09 and is authored by “_____ Isn’t For You”.

The blog states Mr. V. only hires attractive females and then tries to date them / makes sexual advances towards them.  It goes on from there.

This is slanderous and libelous and a complete and total lie!  I am formally requesting this particular blog entry be removed immediately.  If you are unwilling to remove said blog then I will forward onto my legal department for further handling.  Please reply at your earliest convenience.

Thank you for your attention to this urgent matter.

S.H
CS Manager
_____ Medspa

I got another email amost immediately. Evidently my inability to grasp just how urgent this issue is and my lack of action in removing an anonymous post is getting under S.H's' skin. He dicides to forgo any more niceities and threaten me with his 'legal department'. Ouch. Here's S.H's next email.

This is slanderous and libelous and a complete and total lie! I am formally requesting this particular blog entry be removed immediately. If you are unwilling to remove said blog then I will forward onto my legal department for further handling. Please reply at your earliest convenience.

Have to give it to S, he's a silver-tongued devil. I mean, having an entire 'legal department' set on my like wild dogs? Terrifying.

So now I'm dealing with the 'legal department'. Here's what they sent.

Our firm, Kamensky Rubinstein Hochman & Delott, LLP, represents ___ medical spas.

Our client has informed us of various outrageous and defamatory blog postings/comments made on your website http://www.medicalspamd.com/ that impugn the character of Mr. N.V. of ___, specifically postings from "___ Isn't For You!" dated 3/4/09 and 4/10/09 and "former skin medique employee" dated 3/25/09.

In the March 4, 2009 posting, "__ _ Isn't For You!" falsely states that Mr. V only hires attractive females and then tries to date them or makes sexual advances towards them. In addition, "__ _ Isn't For You!" falsely states that if such sexual advances are not accepted, the employee does not get paid. In addition, in "__ _ Isn't For You"'s April 10, 2009 posting it falsely accuses __ _ of "multiple violations of state and federal labor laws, multiple instances of unwanted sexual advances and harassment." Similarly, "former skin medique employee" falsely states that Mr. V is "crooked," a "con artist," and "shady" and further falsely states that "if N.V. is involved . . . It is a scam from the word go."

This is not the type of content expected from a thoughtful website regarding medspas. Accordingly, we request that you immediately remove the postings posted by "__ _ Isn't For You!" dated 3/4/09 and 4/10/09 and "former skin medique employee" dated 3/25/09. We also request that you provide us with the names and all information in your possession relating to "__ _ Isn't For You" and "former skin medique employee."

Now isn't that nice? Within something like 72 hours we've progressed from a simple email request to this Medical Spas' demand that I turn over information on individuals who've made negative comments about them. This medical spa went from trying to get a single comment removed, to making the front page of Medical Spa MD. (Medical spas usually have to pay for that privledge.)

Of course this may not be the kind of publicity that __ _, S.H, and N.V wanted. I can't think that this medspa would really want the fact that one of their corporate officers was once sued by the SEC. But with the nasty-grams that S and his legal department are sending me it made me wonder what all the hubbub's about.

__ _ Medspa: Lessons for S.

Let me take a moment here and discuss what I think S could have done that would have better fit his medical spas business needs.

First: Don't take it personally. Every medical spa is going to have unhappy patients and ex-employees. You can't shut them up. Don't try. Perhaps they're unhappy for a reason. Your best bet is to engage in civil conversation. If you're making decisions on behalf of your medical spa or laser clinic, you need to keep your emotions out of the way. You're going to have dissagreements and sometimes they'll get personal. Don't let it affect your 'actions'. Medical Spa MD doesn't have any interest in harming this medical spa and no Medspa MD author wrote those comments.

But I wasn't responding fast enought to S and he took that as a slight. It wasn't. I don't know S and my first response, 'how can I help you', was an invitation for him to lay out his case. He didn't take advantage of that. Instead he lost focus on what he was trying to accomplish.

Second: Focus on your goal. Sean's goal was simply to get me to remove a comment. It's not unreasonable. I've done it before. I've removed any number of comments that attacked individuals in a way that had nothing to do with their business and was just an attempt to hurt them personally. I don't like those attacks and when I find them, I often remove them and at times, block an IP address so they can't make more.

S lost sight of the goal which was to get a comment removed. Instead, he switched his goal to getting to me. If he'd not been so agressive he'd probably have gotten the offending comment edited or removed. Instead, S pulled a gun by threatening me with his 'legal department'.

Third: Never pull a gun unless you intend to use it. S went nuclear when he had his 'legal department' fire off a demand. If S was smarter, he would have done his homework and seen that Medical Spa MD has been threatened many times by medical spa francises and their lawyers and knows well how to handel cyber-slap lawsuits. Read this Medical Spa MD post on cyberslap lawsuits, legal rights and anonymous comments on the web.

S went 'legal team' way, way too fast. I wasn't being unreasonable. I didn't tell him to 'go to hell'. It just wasn't at the top of my list of things to do. Medial Spa MD can get twenty or thirty contacts a day. I could care less that S demands to talk to me on the phone right away. Get in line. A single anonymous comment doesn't rise to the need of emergency care. S would have done much better with a simple, "I know you're busy" and a written explianation of his need to get a medspa comment removed.

__ _ Medspas legal team doesn't have a leg to stand on demanding information about people who comment on Medical Spa MD either. Anyone has a perfectly legal right to post anonymously on the web. Comments on Medical Spa MD are most commonly anonymous for exactly that reason. Physicians don't want to be held liable for the advice they give to other doctors, and laser technicians working at some laser clinic franchise don't want to lose their job.

Last: Never pull a gun on the person holding the mic. If you don't know what that means... From the begnning, S is making demands and acting pretty agressive, but he's only got one weak pair of twos (his 'legal team') and he plays them right away. Now he's got nothing left. If he's emailing some ex-employee that kind of intimidation might work, but not in this case.

By threatening Medical Spa MD and myself directly he's chosen to make an adversarial relationship when he needed a helpful one. While I don't have any axe to grind against S or __ _ Medical Spas, I don't really appreciate this kind of interaction. Any new threatening communications S or his 'legal department' they'll be posted right here on Medical Spa MD's front page where our 50,000 monthly visitors can decide for themseleves. (I can't think that any named Medspa's physicians will welcome questions about it.)

So where does that leave Medical Spa MD and __ _ medical spas?

For my part I'll put a quick notice up on the Medical Spa comments and take a look at them sometime in the next few days. If there's something that violates our terms, I'll edit or delete it.

I can't think that S has solved his Medical Spas business needs though.

IPL & Lasers from China

I've certainly been getting a lot of IPL & cosmetic laser companies from China contacting me lately trying to get on the site.

I haven't seen one yet that claims FDA approval for their lasers. Does anyone with a laser clinic or medical spa outside the US have experience using lasers or IPLs from China? Are lasers or IPLs a workable solution for clinics in Europe or Asia?

Im guessing that a very large majority of the componants that are used by Palomar, Cutera, or Thermage are manufactured in China already.

The Medical Spa Aesthics Training Course & Study Guide for medspas & laser clinics.

The Medical Spa Aesthetics Training Course & Study Guide for Medspas, Laser Clinics & Cosmetic Medical Practices.

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Written by Paula D. Young, RN, the Advanced Medical Spa Esthetics Training Course & Study Guide is a two part learning cirriculum for non-physicians. The course is delivered in two parts that include a text book and a study guide.

This is an invaluable tool for any Laser Center, Med Spa, Plastic Surgery or Cosmetic Dermatology practice to train every new medical spa staff member on what cosmetic proceedures you offer, how they work, and what alternatives there are.

This study course is being used in medical esthetic schools and leading medical spas and laser clinics to provide every new esthetician and laser tech with a study course, and test their knowledge before they're hired.

For the first time, your laser clinic or medspa staff has the latest information on the newest nonsurgical medical treatments, from Botox, Restylane, and the newest filler injections, to fractional CO2 laser resurfacing and IPL treatments.

Your medical spa staffs knowledge and expertise is a critical componant to your success. Now you can be confident that your front desk, estheticians and laser technicians have the information that they need, and can answer patient questions with confidence.

Memberswill only be available to existing Medical Spa MD Members so be sure that you've signed up for your free membership.

Med Spa & Laser Clinic News

Outlook gets ugly for plastic surgery firm
guardian.co.uk -

Detecting Skin Cancer
CBS News

More than 5000 Dermatologists gather in Dubai to Attend the Ninth Edition of Dubai Derma
Zawya

Plastic surgery for that competitive edge
Globe and Mail

Med Spa & Laser Clinic Yellow Page Advertising

The Fools Gold of Yellow Pages Advertising.

A discussion about usage patterns and investing in the Yellow Pages directory. It’s something of an institution for many small business owners, and I know that many owners out there are terrified at the idea of not running the biggest possible ad they can afford. So far though, I’ve never spoken to a business owner who could substantiate their belief in the power of the Yellow Pages to generate business. The normal answer I’ve been given is ‘yes it works, no I don’t know how well’. Considering the pricing, I would hope it works damn well! It’s easy to drop $20K+ on a few inches of paper.

It amazes me just how many plastic surgeons and dermatologists advertise their presence in the Yellow Pages. (As well as med spas and laser clinics.) If you’ve got one of those big yellow stickers that say “Find me in Yellow Pages” stuck to your car, your door, your wall, or god forbid- included on a brochure or website! Stop what you’re doing right now, go outside, peel it off, and burn it*.

Telling your potential patients that your laser clinic or med spa can be found in the Yellow Pages is a terrible way to promote your practice. If you’ve made enough of an impression that they want to contact you again, you’ve already done the hard part. You’ve stood out from the crowd, you’ve had their attention. Don’t waste this valuable opportunity on a useless referral. Those four evil words “Find me in Yellow” serve the company that owns the directory, not you. Heres some things to think about:Yellow Pages is not strictly alphabetical, it’s a competitive listing. The ‘No.1’ position goes to the highest bidder, with the earliest application. Your prospective patient has to troll through pages of your competitors advertising to find you.

You’re encouraging people to comparison shop. Now that they’ve gone to the trouble of pulling out the phone book, it’s not that much more trouble to just do a quick ‘call around’ and find out who has the best price. You just lost your advantage. (You'll recognize the phone calls that come asking how much for a unit of Botox, laser hair removal, or Thermage.)

You risk that their attention will be drawn to someone else. You could pay a little more for bold typeface, and a border… but that doesn’t change the fact that you’re still buried amongst 15 pages of other plastic surgeons, laser clinics, dermatologists and med spas.

If you want to refer them somewhere, point them to your own website! At least there you won’t give your opposition the chance to steal your patient!

Note: I said your own site. Medical spa and plastic surgeon directories function just like the Yellow Pages, inviting comparison shopping and driving your prices down. And providing a competitve zone listing? Bullshit used to sell to docs who don't know better. There is no 'exclusion zone' on the web. Anyone looking for a laser clinic will damn well find all of your competitors anyway. (I'll be posting about this topic extensively since I get a lot of questions about how to do SEO and SEM for med spas.)

Are yellow page ads working for your laser clinic?

Simple answer: They weren't for me. I pulled the Yellow Page ads for all of our med spas. (Seven clinics in four states.) Over the last seven years, I have found that the money that is spent or should I say gouged on Yellow Page ads is better spent elsewhere.

Yellow Pages were at one time popular before the Internet and competition. In many markets, there are six Yellow Page competitors who are all publishing books. In order to run a full-page, full-color ad in all of them, I would be looking at about $20,000 a month, which I think is absolutely ridiculous.

Yellow Page salespeople will tell you that 50% or 40% or some other percentage of people who are looking for your type of business are going to be able to find you in the Yellow Pages.

That is true... kind of*.

What really happens is people hear about your med spa or dermatology office and then they will search for you in order to find out your telephone number. That's a vastly different value proposition from the way that Yellow Pages are really sold to you as which is direct advertising. The Internet has made it so easy to find any information. The Yellow Pages for the most part are now irrelevant.

Now, I've tried individual phone numbers and a number of other things in order to track our ROI, but what we find out when we actually talk to our patients (every patient that comes into one of our clinics is given a questionnaire in which case they fill out where they heard about us and also if they have heard about us before) the vast majority are just using Yellow Pages in order to look up our phone number. (I think probably 100% of people who fill out that they called us from the Yellow Pages also fill out that they have heard of us someplace before) Of those same patients only about 3% do not have Internet access. As more and more people switch to the Internet for their information needs, the Yellow Pages become less and less relevant, and the opportunity cost for that money becomes greater and greater.

I would be interested in hearing what your thoughts are on the Yellow Page ads that you run (or don't).

---

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Plastic Surgeon & Dermatologist Marketing Online: Is click fraud draining your advertising budget?

If you're one of the thousands of plastic surgeons, dermatologists, laser clincs and medical spas advertising online with Google Adwords or Yahoo, don't be surprised to find that at least some of the money you're paying every month is generated by click fraud.

Don't think it's happening to your skin clinic? Here's a quote from Michael Caruso, CEO of click fraud services vendor ClickFacts in an interview with Marketing Sherpa:

In some particularly fraud prone verticals such as finance, class action lawsuits and medical, ClickFacts sees rates in the 30%-45% range. These are all categories that see high keyword pricing in the auction model. That makes them particularly tasty for click fraud artists. “If you can make more money from the dark side than the light side of search, there are plenty of people who will take advantage. Plus, it’s not even technically illegal yet.

Two ways that your plastic surgery or medical spa marketing budget is being drained:

Competitors who see your ad simply click on it, draining your advertising dollars, or 'affiliate' sites are set up that run your ads where they are clicked on by bots or employees. These sites are the most damaging since you're paying for every click without any return. Click fraud for medical spas can be very lucrative since medspas are becoming such a competitive market and the payment per click can be as high as $4-5.

To keep your budget safe you have very few tools. Google just advertisers $90 million to compensate for click fraud as the result of a class action suit but you can bet they're not that interested in your individual account. Especially since they're making money from click fraud too.

Start by limiting your exposure to click fraud. If you're still running an Adwords or Yahoo campaign, they allow you to limit the maximum amount you spend in a day. Take advantage of this feature by limiting your maximum cost to what you can afford to spend. You can also look for the tracks of click fraud by examining the reports you might have available to you. Multiple clicks coming from the same IP address are a sure sign of fraud.

Malaysia has become such a haven for click fraud 'sweat-shops' that clicks generated there are completely discounted and Malaysian accounts for Adwords or Overture are not granted.

If you're going to run search ads, try to protect yourself. You can be sure that you're the only one trying to.

IPL Burns

The Independent newspaper in the UK has an article today in their Health & Wellbeing section from a reporter who was badly burned by an IPL treatment at a 'Top London Med Spa'.

The photos show the reporter with large uneven red welts on her chest and areas of redness on her face also. According to the story the correspondent was seduced by the promise of a `fast and effective way of removing the visible ravages of time without surgery’.

This is the second high profile newspaper report in recent times (see also News anchor gets burned by photo facial). I wish this were even less common than it is, but I've seen a number of IPL & laser burns before. These are often the result of rogue operations (Mesotherapy Lipodisolve Horror Stories) poorly trained staff AND physicians who intimidate their staff.

If your a plastic surgeon or dermatologist running a skin clinic, med spa, or laser clinic and your staffs first reaction is not to tell you somethings going wrong or they're not sure about an IPL or laser setting, you're just setting yourself up to have problems.

These types of IPL and laser burns are almost invaraibly the result of a physician who has medical estheticians or laser technicians who are afraid of confronting them with a problem or question. The doctor's defense? They were told what to do... but problems always arise and doctors who don't want to be hassled are the ones putting both their patitent and their laser clinic at risk. It's just a numbers game. If you treat 1000 patients at least some of them will have problems. Your staff should never be repremanded or belittled for ANY question.

The technician told me she would use a strong setting to get better results. As she passed the handpiece across my face the feeling grew hotter and hotter. By the time the device reached my neck, I could barely imagine continuing with the burning sensation. When she started on my chest the pain was intolerable and I had to ask her to stop repeatedly before continuing with what felt like torture. I'd thought of "no pain, no gain" and I soldiered on.

I got dressed, with a burning hot chest and a face that looked as if I'd been pulled out of a forest fire.

I was scheduled to return in two weeks for the next IPL treatment, in a course of six that costs £1,200. I went to a make-up shop and was dusted with a mineral powder, suggested by the spa, to camouflage the redness of my face.

A woman at the same counter asked me what the hell I'd had done. When I proudly informed her I'd had an IPL photo facial – she looked at me with total horror. "I don't mean to worry you, but I've had a course and it never looked like that." I largely shrugged off her words of warning. Why would I question the skill of a technician at the high end of the market? It's not as if I'd taken a chance and visited a high-street beauty parlour.

When I got home and looked in the mirror at my chest for the first time since the treatment - only an hour later – I was horrified. Angry red rectangular burns covered my chest in a random grid. Little did I know when I'd set off that morning that I would return after my first exciting treatment scorched and traumatised. What made no sense to me was that the treatment had not been done uniformly which was more obvious on my chest where I looked like I'd been branded with a hot iron.

The next day, on the advice of a friend, I called a top dermatologist – Dr Nick Lowe – known as the god of dermatology. He is also the man the rich and famous depend on when they need to be fixed, without resorting to the knife.

Dr Lowe saw me as a medical emergency the following morning. He works at the Cranley Clinic, off Harley Street, London, has a private practice in Santa Monica, California, and is clinical professor of dermatology at the UCLA School of Medicine, Los Angeles. He has his own skin care range and is the author of many books, including, most recently, The Wrinkle Revolution.

He was horrified by what he saw and concerned that no doctor was present at the IPL treatment – but it didn't surprise him. Along with other doctors, he is lobbying to get these types of treatments regulated in the UK. He believes treatments including Botox, line fillers, laser and light should only be conducted by doctors or administered under a doctor's supervision.

"The UK is one of the few countries in Europe that does not have sound legislation. It is much more regulated in France, Spain and Italy where only trained doctors can administer these treatments. The UK has failed totally to protect the public in this arena," says Dr Lowe.

Laser Clinic & Med Spa Group Visits?

The Doctor will see you,alll, now: Group Appointments Give Patients More Time To Talk

Chang's office began offering such group visits only for patients with diabetes, and then for people with asthma. Instead of spending 10 or 15 minutes each with 10 patients — many of whom need to hear the same thing — she might spend 90 minutes with 18 patients. Each patient learns from others' questions and symptoms, and the doctor covers much more.

Group visits

Studies have found that patients attending group visits had fewer emergency room and specialist visits (and thus lower monthly costs), stayed healthier and were more satisfied with their care. Three models exist.Cooperative health care clinic, created by Dr. John Scott in Wheat Ridge, Colo., in 1991, is an alternative to individual doctor visits. The same group of patients usually sees the doctor together monthly. Specialty group visits, which Scott developed in 1995, are similar, but patients have the same diagnosis, such as pregnancy, diabetes, hypertension, arthritis or fibromyalgia.Drop-in group medical appointments, developed in 1996 by clinical psychologist Edward Noffsinger in San Jose, Calif., typically have different patients at each session.

I wonder if you could do this in a cosmetic setting. Has anyone tried something like this in your med spa or laser clinc?

Brazilian & Bikini Line Laser Hair Removal

Brazilian or bikini line laser hair removal can be classified in four types that has variable names depending on the med spa or laser clinic visited.

It has been claimed that Brazilian laser hair removal, the most renowned form, was named after a pair of Brazilian sisters who delivered the service  as a waxing treatment in New York.

• The American: bikini line laser hair removal is removal of hair at the top of the thighs and under the navel when wearing a bikini. It is also known as a basic bikini line.
• French bikini line: leaves a vertical strip in front (a landing strip), two to three finger-widths in length just above the vulva. It is also known as a partial Brazilian laser hair removal. Hair of the peri-anal area and labia may be removed. Removal of hair from these areas is also known as the 'Playboy' or 'G-waxing'.
• Brazilian refers to a removal of everything, front to back, while sometimes leaving a thin strip of hair on the pubis. An extreme form of bikini line laser hair removal, it involves complete removal of hair from the buttocks and adjacent to the anus, perineum and vulva (labia majora and mons pubis). Laser hari removal reatments that remove all of the pubic hair are known as a full Brazilian, full Bikini line, Hollywood wax or the Sphinx.

Further subgroups has been proposed by Anthropologist Desmond Morris, while referring to inconsistency in nomenclature:

• The Bikini Line: This is the least extreme form. All (most) pubic hair covered by the bikini is left in place. Only straggling hairs on either side are removed, so that none are visible when a bikini with high-cut sides is being worn.
• The Full Bikini: Only a small amount of hair is left, on the Mount of Venus (the mons pubis)
• The European: All pubic hair is removed 'except for a small patch on the mound'.
• The Triangle: All pubic hair is removed except for a sharply trimmed triangle.
• The Moustache: Everything is removed except for a wide, rectangular patch. This is sometimes called 'The Hitler's Moustache', sometimes 'Chaplin's Moustache'.
• The Heart: The main pubic tuft is shaped into a heart symbol.
• The Landing Strip: The central hair is trimmed into a narrow vertical strip and all other pubic hair is removed. This has become popular with models who must wear garments of an extreme narrowness in the crotch.
• The Playboy Strip: Everything is removed except for a long, narrow rectangle of hair.
• The Brazilian: This is the most famous of the bikini line laser hair removal styles but there is some confusion about its excact form. To some it is the same as the Landing Strip, leaving only a 'vertical stripe of hair'. To still others it signifies the complete removal of all pubic hair.
• The Sphynx: This is unambiguously the 'everything off' style, leaving a completely hairless pubic region. The name is derived from that of a naked breed of cat from Canada. Some laser clinics and med spas refer to 'the Sphynx' as 'the Hollywood'.

1800LaserHair.com: Another laser clinic directory wannabe spamming Med Spa MD.

Ok, I'm more than just a little tired of some of the bull shit that certain laser clinic and plastic surgery directories spamming the site and posting positive anonymous reviews of their services and laser hair removal listings.

So, there are about to be some very public spankings.

Medical Spa MD has attained some popularity, and some clout with physicians running laser clinics. I receive regular iquiries from docs looking for advice on cosmetic lasers and I personally know of a number of doctors who have printed out reviews from Med Spa MD and asked cosmetic laser sales reps about them. There are laser companies who are now Medspa MD members and (to my current understanding) are welcome members to the community.

However, there are some cheap laser clinc and plastic surgery directories that think that you're an idiot and post comments like those below. (There've also been some physicians offering their 'expertise' as trainers who have tried this to promote their training.) Don't. You've been warned.

1800laserhair.com: I don't know if 1800laserhair.com is posting these comments as part of their corporate policiy or if it's just a rogue individual salesman who's doing it for them. I also don't care. My guess is that they're some small little hack job outfit. It pisses me off personal that whoever this is thinks that this won't be found out.

Here's an example of laser clinc directory, 1800laserhair.com who posted this rave review to Med Spa MD under the name Dr. Don:

I have the two Candelas yag alexandrite and a light sheer diode. I use a service tech that is awesome and reasonable. I can't remember his name right off but I got his name from this great referral network I belong to. Call 1-800 Laser hair ask for Nancy or go to their website WWW.1800laserhair.com There may be a link but I think I got the guys name directly from Nancy. His name is Robert something... BTW anyone slow or having advertising or marketing issues, I am getting tons of referrals from the 1-800-laser hair network. You have to meet their criteria, they are very picky and exclusive but if they will accept you join!!! Two colleagues of mine were denied I am not sure why. The leads are great worth every dime. I resisted their advice at first, them I put my wife in charge of all of it, she followed their program to the letter now we are so overwhelmed with calls for laser (Not really what I want to be doing but I better not complain because laser hair removal is supporting my practice through this crappy economy. Nice plug for them...tell them Dr. Don sent you...I may get some referral bonus!! LOL

Back to Laser Hair removal service. I don't have a service contract. Don't get them. I regularly get laser check-ups. Robert (the service guy) calls my office when he is in my area. By getting him in when he is already in my area he gives me a break on service costs. I get the check-ups and do preventative laser maintenance. Also Nancy (the 1-800 laser hair removal lady) gave me a monthly weekly and daily check list that tells us how to properly maintain our lasers in between service visits. I have not had a significant laser repair cost in 7 years and I haven't had to replace a laser yet going on 10 years. After we got our staff to follow the checklist diligently we saw a significant drop in repair costs. My staff was going through thousands of dollars worth of parts yearly and I was watching our profits go to Candela, I too despise them. They have terrible service and they have been so shady. I think they would sell their grandmothers if they could make a buck!!! Their service contracts are totally over priced. bad plug!!

I really don't use the light sheer much but I keep it for a back up, just in case. Robert can usually fly in for emergency repairs next day. So I have never really needed it.

Posted As: DrDon

Posted Email: wtawtawdba@yahoo.com

Posted Link: www.1800laserhair.com

Comment Posted From This IP Address: user-24-96-114-40.knology.net (24.96.114.40)

I have to laugh at these claims of exclusivity. "You have to meet their criteria, they are very picky and exclusive but if they will accept you join!!!" Sure.

If I were Candela I'd be contacting my legal department about now. This is a perfect case of liable; posting damaging comments as fact under an assumed name. Candella can't be happy that these laser hair removal guys are bad-mouthing them and servicing their lasers at the same time.

Does anyone fall for these laser hair removal guys? I'd be interested in hearing what any identified physician using 1800laserhair.com thinks about their "tons of referrals from the 1-800-laser hair network."

If anyone has an email from 1800laserhair.com that they have archived in their inbox, I'd be interested in seeing it since the IP address is included. We could compare the two. I'd expect that they change their IP address shortly if they happen to match.

PS: This IP address has been banned.

Med Spa vs Laser Clinic: Analyzing your medical spa competiton.

Get to know the laser clinic and med spa competition.

Contrary to what some may say, growing your clinic or medical spa isn't a single event.

Successful clinics and medspas look for 'incremental wins' that compound over time. The key to winning market share is to differentiate your company by providing products, services or solutions that your best prospects will find more desirable than what's offered by your competitors.

Experienced marketers know it's easier to fill an existing need than to create one. Someone who is already using the type of product or service you offer is a great prospect because he or she has a clearly defined need and is looking for a solution.

The job of convincing qualified prospects to buy from you instead of your competitors' is where the real work begins. One of the first steps is knowing what the other clinics, day spas, medical spas, and others who might be competing are up to in your market.

1. Do some detective work. Ok, this is a little spy like, but don't think all of your competitors aren't doing it to you and it's just good business sense. Start by gathering your competitors' marketing tools and advertising materials. Read their web site, print and broadcast advertising, and articles in which they've been featured. Request their brochures, price lists and any collateral materials. You may also be able to do some mystery shopping, which will allow you to experience what these medical spas are offering and how their positioning themselves. You'll want to send your staff rather than visiting yourself if you want to avoid embarrassing situations. (Surface has had more than 45 plastic surgeons, dermatologists and other physicians attend our seminars over the last five years in this type of sneaky capacity. They're not hard to spot and often they're 'outed' by women in the audience. They're the guys (mostly) who are sitting in the back scribbling furiously while their estheticians sit up front and ask telling questions like, "Now types of sutures do you use?".)

2. Evaluate your "slant" competitors. Chances are, you have a lot more competitors than you think. In addition to real competitors, evaluate the marketing tools and materials of any businesses your prospects perceive as offering a similar set of products or services. It's very common for day spas to attempt to compete with medical practices by offering a few medical services from a NP or PA. Microderm is often touted as some sort of medical type treatment. OBGYN's, FP's, pretty much whoever is in the market or wanting to get in. Know who's saying what about you.

3. Focus on the message. Once you've gathered the materials, the next step is to analyze what's being communicated and how. Identify the key promises made by your broad field of competitors. And don't be surprised if you see a lot of "me too" marketing. There's so much out there that's mediocre or worse, you may find the majority of your competitors have similar messaging, with only a few front-runners showing anything approaching real positioning. (This probably refers to you but we'll work on that.)

After assessing the most effective messaging, look at the actual tools and materials themselves. What formats seem to work best overall? At this point, your competitive analysis will reveal whether your company is lacking any standard tools that prospects expect everyone in your industry to offer.

4. Find a unique spin. So now comes the 'look in the mirror' moment. You've gathered all the materials and have learned the key message points of your real and perceived competitors. It all boils down to this: How does your clinic meet its patients' needs in a way that is both unique and compelling?

To find the answer, consider not only the products or services you sell, but also how you operate, including any company-specific characteristics, such as a higher level of customer service or uniquely specific positioning. If you can't find a selling point based on your current service offering that will help you stand out from your competitors, use what you've learned in this competitive analysis to retool what you sell and how you sell it.

If you can't see any difference between yourself and your competitors, why should you think any patient would choose you?