Planning Ahead For Equipment Failures

It's inevitable. At some point your cosmetic laser or IPL will go on the fritz. Then what?

About half of the people I speak to every day are medical spa owners. The nature of my job pretty much implies that most people calling me are in some type of situation they would consider an emergency. Most have just one cosmetic laser or IPL, a schedule full of customers, and no time. A week of searching for a repair company or technician can put a medical spa in a very bad situation. Unexpected service expenses are not so... they should be expected, but they are ignored.

How does one prepare for such unforeseen expenses as the need for a laser cavity rebuild, a power supply repair, or laser rod resurface- all repairs that can result in at least a week of downtime? This problem can best be remedied at the time of purchase, but most of you are far beyond this point. There are few options, but there are options.

The very best option in contingency planning for unexpected repairs is to warranty your devices. This is best done when purchasing your new or used laser- new lasers should come with a minimum 12 month warranty, and you should never purchase a used laser from a company that cannot offer at least a 6 month warranty after purchase. Many dealers and third party service companies now offer warranties on a wide variety of laser makes and models, but to know who offers what you may have to ask around. Some of these third party warranties offer more for the money than the original equipment manufacturer warranty, but come with the caveat that there are parts that may not be readily available at all times.

Another option to consider, even if you have a warranty, is a backup unit or rental. If you can only afford one laser, teaming up with local colleagues is one way to alleviate this problem. If you have a Cutera Xeo, for example, you can seek out colleagues in your area who also use the Cutera Xeo and together purchase a standby unit that is only used in case of emergencies. You might also ask your warranty company if they are capable of providing loaner units while yours is in repair.

The third option to consider is leasing your unit. Under a lease, you are not directly responsible for all the maintenance. In case of emergency, the leasing company should be able to provide a loaner or temporary unit. I am not referring to a lease as in taking out a loan from a bank to pay for what will be your laser- I mean leasing the laser from an owner who will handle all the maintenance should anything go wrong. These kinds of arrangements do include clauses where you may be responsible for negligence, equipment abuse, and misuse, but most lasers fail because of normal wear and tear.

Of course, none of these options will alleviate every emergency situation. The best course of action may be a combination of these options, or all three. Even though there is no catch all, HAVING a plan, or at least being aware of the possibility of an unforeseen expense is more than ignoring the possibility in it's entirety.

Have a question? Please leave a comment.

Every Day Maintenance Of Your Cosmetic Lasers & IPLs

Your cosmetic lasers and IPLs need some basic care and maintenance. What should you be doing?

Many people ask me if there is anything they can do to prevent their laser from breaking down without having to call in a technician every time. While there is not much you can do for normal wear and tear breakdowns, there are a few things you can do that will ensure your unit is in top condition between maintenance checks. This is in no way intended to replace any manufacturer's recommended periodic operator maintenance procedures, nor is this intended to replace periodic maintenance in any way. I still recommend that every laser used on patients should be checked every six months by a trained professional.

Basic checks on your laser can be broken down into modules. To make certain practices a habit, most people need to know why they are performing a task. I will first break down basic laser systems into the 5 modules that make up every laser, and then the basic things you can do to maintain these modules:

Power Supply / Exciter

Stimulated emission of radiation occurs when a lasing medium is excited, and forced to release it's own photons in a wavelength specific to that lasing medium. CO2 lasers, for example, use either an RF exciter, or a DC exciter. Yag lasers use a high powered flashlamp- it is not the flashlamp light that is collimated and amplified, rather the flashlamp excites the Yag crystal and forces it to release photons in wavelegnth specific to the crystal, ie. 1064nm. An exciter can also be a chemical reaction, as with Excimer lasers (excited dimer). A bad power supply will result in some obvious errors like the laser not powering on, but it can also result in intermittent issues or problems more difficult to find like peak power settings not being selectable, or certain pulsewidths not being available.

What can you do to maintain your power supply? Power supplies are mostly affected by wall outlet power. Ensure you are using medical grade power outlets, and a dedicated line. A medical grade outlet will be indicated by a green dot on most 110VAC outlets, but 220VAC outlets will not have this dot. For 220VAC systems, make sure you are getting "healthy" power... that is anywhere between 218VAC and 237VAC for most systems. I don't know of any systems rated for higher than 240VAC, but I have seen power as high as 247VAC at some facilities. This is not acceptable, and power should be maintained in the safe zone for your laser. This info is available in your operator's or service manual.

Laser Cavity / Resonator / Laser Head

This is the heart of your laser. This consists of your lasing medium (crystal, dye, or gas), a highly reflective surface or HR mirror, and an output coupler or partially reflective surface. Oftentimes the flashlamp will be in the laser cavity itself as with Yag and Alex lasers. Many issues with other system modules will cause problems in the laser cavity. The worst enemies of your laser cavity are heat, and of course, time. An old, worn, or dirty laser cavity will overwork your power supply which is working extra hard to excite your medium because the internal test results are low. This may result in power output errors, detector mismatch errors, flashlamp ignition errors, etc.

What can you do to maintain your laser cavity? The best way to maintain your laser cavity is to monitor your power output over time. Have your laser checked every six months by a trained professional, and at least once a year, have them inspect the internal condition of your cavity. Though you may get an unexpected expense at a random six month interval it is much better to catch problems during these inspections rather than having your unit shut down during a case, and resulting in canceled appointments. Maintaining your other subsystems also extends the life of your resonator.

Optics Train / Beam Path Optics

These are the optics between your laser cavity, and your delivery optics. Some laser don't have anything more than a fiber focus lens between the output coupler and fiber. The Cynosure Apogee Elite, for example, on the Alex side, has nothing more than a surface output coupler (a partially reflective surface on the output side of the Alexandrite crystal), and from there the beam goes into a fiber focus lens, and directly into the fiber. A Cutera Xeo's crystal is different- it requires an external output coupler, and a rear HR mirror. The beam bath also takes two turns before it reaches the fiber focus lens. CO2 lasers, and some Erbium lasers use an arm. Every knuckle in the arm has a mirror that can be adjusted and may require cleaning over time.

What can you do to maintain your cosmetc lasers optics? Best advice- keep your room lint and dust free. I can't emphasize this enough: KEEP YOUR PROCEDURE ROOM FREE OF DUST AND LINT. Clean up as much as possible. Wipe down your system as often as possible. Change any filters that can be changed, and clean others (this includes office HVAC system filters). To preserve alignment, take care when transporting the laser, and the best thing you can do is not transport it at all.

Delivery Optics

This may consist solely of your handpiece, but in some cases (as with an arm) it may consist of a train of mirrors. The fiber focus lens is also part of the delivery optics. Problems with the beam path and delivery optics will result in calibration errors where a handpiece calibration is required, or diminished output not readily noticeable to the operator in some cases. In other cases, a bad alignment may cause heat, burning in the handpiece, and other issues noticeable to the operator.

Besides the same advice I can give for the beam path optics, take care not to drop your hand piece! If you have a laser with an arm, PARK THE ARM before moving your laser around. Stow the arm safely when not in use. Clean your hand pieces after every patient. Replace blast shield windows periodically. Replace distance gauges more often than you think necessary- it is better to replace distance gauges than it is to replace hand piece optics. And FYI- any dirty optic will have an effect on the entire laser train.

Cooling System

The cooling system in most lasers consists of a water reservoir, a heat exchanger, a water pump, a water level detector, a water pressure detector, DI and/or particle filters, and tubing throughout the system. Some cooling systems include a heating element as well to maintain a specific temperature (as with Alex systems). Distilled water is normally used to fill these systems, but some manufacturers may require a coolant additive as well. The cooling system is often used to cool the laser cavity, handpiece (in some lasers), and power supply (in some lasers).

To maintain your cooling system, the best thing you can do is use reagent grade deionized water. When that is not realistic, use NOTHING less than distilled water. Again, replace any replaceable filters, and clean any that are not. Clean your heat exchanger/ratiator as often as possible, and never let a blanket of dust form on your radiator. Another thing you can do is grab a voltmeter, set it to read Ohms, stick your leads in the water reservoir about an inch apart from each other and read your resistance. The ideal resistance for Deionized water is 2MOhms. If it is lower than 1MOhm, I would recommend replacing the DI filter and possibly the particle filter as well (if there is one).

I know none of these things are actually going to prevent a catastrophic/emergency failure, but they may help you avert one, or at least be aware when one is looming. Heat, time, dust and movement is what will eventually take out your laser. These are just ways to avoid letting these things run your laser down prematurely.

Questions about any of this? Please leave a comment.

Beware of Buying Used Medical Lasers From Brokers

Here are some things you need to know about the used laser market.

First of all, some of the people in it are very shady. Second, it is not standardized like the used car industry. There is not a “blue-book” value for used laser equipment. Prices and quality vary widely across the board. You usually don’t get a chance to check out (or test drive) the equipment you are purchasing. There is no lemon law with used lasers. When you buy it, it’s yours. It may be difficult getting your money back if it doesn’t perform. Most of these used dealers are not real companies. They are some guy who probably doesn’t even have the laser, but is instead brokering it. There are no real warranties with the equipment. The following are things you should look for in a laser broker and ask:

• Does the laser broker actually have the laser in his/her possession or is it a consignment sale? If it is a consignment sale, you need to do your own due diligence on what condition the laser is in because you can’t always rely on the broker giving you accurate information. Since the broker may have never actually physically seen the device, he/she may not know if there are any flaws with the device. He or she is relying solely on the doctor who owns the device to give him accurate information.
• Has this broker been certified by third parties and received a seal of reliability and ethics? Below are a few of the certifications that can be helpful in your assessment:
• Dotmed. An online website that certifies laser brokers is Dotmed (found on the internet http://www.Dotmed.com). Find out if your laser broker is Dotmed Certified.
• Ebay.  Every Ebay seller should have a seller’s rating. Find out if your broker has sold on the internet and what his satisfaction rating is. You want to see as close to 100% satisfaction as possible.

These certifications mean a lot to laser dealers and brokers because it validates their good reputation. Brokers and dealers who plan on selling medical lasers for many years to come do not want anything to happen to these ratings because they realize how important they are in selling equipment.

• Has the broker had the equipment inspected by someone qualified to repair the laser prior to shipping? Even used lasers cost a lot of money, so it behooves you to make sure the laser that you’re buying has been properly inspected prior to purchasing. This should be done by a technician who knows the laser and should be done before you put any money down. Would you buy a used car from a fly by night dealer without having your mechanic look at it? Once it’s been purchased, all bets are off. Apply leverage to the broker when you have leverage, and that is prior to purchasing.

Many brokers tout that their laser equipment has been “refurbished.” This statement means absolutely nothing if the laser broker cannot provide documentation of the laser’s refurbishment. If they claim it has been refurbished, they should be able to send you a checklist of items that have been done to the laser in a matter of minutes via email or fax. If they cannot provide this to you in relatively short order, then nothing has been truly done to this unit.

If you have any doubt as to the laser’s condition, you can also ask the broker to shoot a video of the laser in operation, showing the following:

1. The laser being fired
2. The pulse count on the screen
3. The user adjusting the treatment parameters on the screen
4. The serial number of the unit.
5. Any material defects the laser may have that need to be disclosed

The bottom line is this: You want to make sure the laser is in good, operating condition. You need to make sure it is actually functioning. Shooting video these days is extremely easy. You can buy a Flip HD video camcorder for less than $200 and shoot high resolution video that can be uploaded directly to YouTube in a matter of minutes. Don’t let this process intimidate you. You are about to make a very large investment. Asking these items of your broker shouldn’t be seen as excessive.

4.   The Importance of a Laser Inspection Checklist

How do you know if a laser has been inspected or “refurbished”? Ask for a laser inspection checklist that has been completed by someone qualified to perform the inspection. Below is a basic laser checklist THAT SHOULD BE PERFORMED ON ANY LASER PRIOR TO BEING SOLD TO ANOTHER PARTY:

Laser Inspection and Maintenance Checklist

Inspection / Maintenance Item Date Completed Tech Initials
1. Check coolant level and add deionized water.
2. Inspect electrical connections.
3. Perform power meter calibration check.
4. If more than 250,000 shots replace deionizer cartridge and DI water.
5. Inspect and clean internal optics (if applicable)
6. Replace Xenon flash lamp if power is low and more 250,000 shots.
7. Inspect footswitch for proper operation.
8. Verify laser has no leaks after replacing any filters or connections.
9. Check High Voltage Power Supply.
10. Verify operation at all power settings.
Signed:_____________________________________Date:_________________________
Laser Repair Company:____________________________ Phone:___________________

In most cases, the inspection checklist will not have been performed prior to the broker listing the item, however you should make it a condition of the sale that the laser be properly inspected. If you do not require this, you will be buying at your own risk.

• Can the broker provide you with a service report on the laser while it was under the manufacturers warranty?  In addition to the laser inspection checklist, you should also request any and all laser service reports that documents any maintenance that has been done on the laser since it was purchased new.  Sometimes the selling doctor may no longer have a record of this, however this should also be available from the laser manufacturer.  Manufacturers have a responsibility to document all repair and maintenance work that has been done to the laser as part of any warranty they have provided for the laser when it was purchased new.

Brokers can be hesitant to provide you with a serial number of the laser because they do not own the laser.  With a serial number you can call the manufacturer and find out where the laser is and sometimes who actually owns the laser.  This makes brokers nervous because it means that you can potentially go around them and buy directly from the owner of the laser unit. Such behavior is completely unethical, however it does sometimes happen which is why laser brokers are very careful about providing such information to you.

• Can the broker provide you with at least 5 references within the past 3 months of doctors he has sold to?  Not every transaction will always run smoothly every time with a broker, however does the broker adjust to problems and ensure that things get back on track to keep the buyer happy?  Calling references of recent transactions will allow you to find out from buyer’s their level of satisfaction with the broker and whether they would do business with him or her again.

We have special offers on the lasers on our classifieds section, and all of them are in GOOD condition. So come and check it out until supplies last.

Identifying Third Party Companies Who Can Repair Your Used Medical Laser BEFORE You Buy

Before you buy a used medical laser, it is critical that you identify third party companies who can repair it. You can’t always rely on the manufacturer to support your used laser. As was already mentioned, manufacturers will often turn their back on any doctor who has not purchased a new laser directly from them.

It is important that you find out from your broker who they use to repair the lasers they are selling you. You need to ask them which laser repair companies are “the best” third party repair companies. You want to get names and phone numbers of specific people who have experience repairing the lasers you wish to purchase.

After 90 days of warranty from the broker who sold you the laser, you will be “on your own” and you need to make sure you can continue to get the support you need for your used laser. You need to conduct your own independent research on the internet (I prefer using Google) to find out the following information from third party repair companies:

1. Identify at least 3 or 4 companies who specialize in repairing the used laser you wish to purchase
2. Ask them to provide you with at least 5 or 6 references of people they have recently serviced
3. Find out whether they have laser repair techs who have been Manufacturer-Certified to work on your used laser
4. Find out if they can obtain parts for your laser. Many manufacturers make it very hard for anyone outside their network to obtain parts such as laser fibers and dye kits. Don’t forget that laser and IPL parts are typically unique to one particular device. Some laser companies won’t even warranty the laser for you if it is not purchased directly from them.
5. Find out whether they have the diagnostic software from the manufacturer to trouble shoot problems with the device
6. Ask them to tell you the most common repairs the device needs and a ball park cost to repair the most common problems
7. Whether the company can offer you a third party extended warranty on the laser, how much it costs, and what all it covers.

You need to do this footwork BEFORE you buy. After you buy it can be too late and you may be taking too large of a risk.

The Truth About Used Medical Laser Warranties

Laser brokers typically give you a 90 Day Warranty when you buy a used laser, but they are really just gambling that it won’t break down during those 90 days. If it does, they have to get someone to service the laser, get parts etc. so be ready to be down for awhile if this happens. In addition, the cost of the repair is coming out of their gross profit from the sale, so they may wish to drag their feet to avoid paying these costs. A good broker will deal with the issue head-on and get it taken care of immediately. Every day that your laser is not functioning is a day you are losing money and the broker should and must respond QUICKLY to this emergency.

Paying top dollar for new equipment allows peace of mind with warranty protection, but it comes at a very high cost. While it is true that most used laser equipment is no longer under a manufacturer’s warranty, research has shown that you are almost ALWAYS better off buying used equipment and paying out of pocket for maintenance and repairs versus buying new and having it covered under warranty. You are simply paying too high of a premium for the luxury of buying new. If peace of mind is the issue, then buy a back-up piece of equipment at a 70% discount that you can rely on when your primary equipment goes down. The reality is you will still be paying less than buying the brand new piece of equipment or a manufacturer’s warranty.

The truth about buying manufacturer warranties is this: They are extremely expensive and are written HEAVILY in the favor of the manufacturer. If nothing goes wrong with your laser device while under warranty, you normally have nothing to show for the money you have expended. We call this “vaporware” because the only thing you bought was a little peace of mind for a short period of time. This money can never be retrieved and is forever lost. Instead of buying “vaporware,” how about buying a back-up piece of hardware? This will give you peace of mind AND something to actually show for your money.

Laser companies do not like customers buying on the used market. They will treat you like a second class citizen and you will get third rate service and response from them. Depending on what laser you are looking to buy and how much training and upkeep it requires should be the main factors. Certain lasers have a good history of maintenance and others have a poor. It will be important to do your research on which lasers and manufacturers have a history of reliability and quality.

You also need to find out which laser manufacturers are user-friendly to pre-owned equipment. Some manufacturers can charge you a laser “RECERTIFICATION FEE.” Recertification fees are sometimes required by the manufacture if the laser device is sold to someone else. The laser manufactures claim it is to ensure the device has not been tampered with, however the real reason is to protect the manufacturer from being undersold by doctors looking to sell their used equipment. Charging a “recertification fee” levels the playing field between the new and used price. These fees can be as high as $25,000.

Thinking of purchasing a used cosmetic laser? Get the best deals here with us.

Why Medical Spas Fail Reason #1: Paying Too Much for Equipment and Build-Out

Investing in an aesthetic practice can be very costly.

You can easily drop $700,000 to over a million to get your practice established.  Paying top dollar for new equipment allows peace of mind with warranty protection, but it comes at a very high cost.  While it is true that most used laser equipment is no longer under a manufacturer’s warranty, research has shown that you are almost ALWAYS better off buying used equipment and paying out of pocket for maintenance and repairs versus buying new and having it covered under warranty.  You are simply paying too high of a premium for the luxury of buying new.  If peace of mind is the issue, then buy a back-up piece of equipment at a 70% discount that you can rely on when your primary equipment goes down.  The reality is you will still be paying less than buying the brand new piece of equipment.

The key to this issue is to identify the companies who repair the used equipment you are considering to purchase.  Ask them to quote you prices on repairs and warranties if you have them.  Also make sure that parts are readily available for this equipment and that the equipment manufacture does not hold a monopoly on spare parts.  You need to do this footwork BEFORE you buy.  After you buy it can be too late and you may be taking too large of a risk.

You also need to find out which laser manufacturers are user-friendly to pre-owned equipment.  Some manufacturers can charge you a laser “RECERTIFICATION FEE.”  Recertification fees are sometimes required by the manufacture if the laser device is sold to someone else.  The laser manufactures claim it is to ensure the device has not been tampered with, however the real reason is to protect the manufacturer from being undersold by doctors looking to sell their used equipment.  Charging a “recertification fee” levels the playing field between the new and used price.  These fees can be as high as $25,000.

Sadly, most aesthetic equipment becomes obsolete 2 or 3 years after the initial purchase, however most leases on that same equipment last for 5 or 6 years.  In the world of aesthetics, technology is evolving at a rapid pace.  This evolution also means that technology does not remain useful for very long.  It’s a hard pill to swallow when you continue to make monthly lease payments on equipment that has become a “doorstop” inside your practice.  If you’ve paid top dollar for that equipment, it just makes that pill you’re swallowing even the more bitter.

Let’s use an example to illustrate this point.  If your practice buys a new Laser Gadget and your competitor buys the same Laser Gadget pre-owned at a 70% discount, your competitor has a large competitive advantage over you.  His fixed costs on capital equipment are 70% less than yours which means higher profit margins for him.  He also has the ability to offer lower treatment prices and potentially put you out of business.  You also have the option to match his lower prices, but you will need to compensate for the higher costs you are paying on that equipment by having a higher treatment volume.  If you choose to keep your prices higher, then you will need to somehow differentiate your practice from the competition by offering other “value-added” benefits that justify your higher prices.  This could be “Board Certified Dermatologist” or “Onsite Physician” etc.

If you feel strongly about buying new laser equipment versus used, do not accept the sticker price presented to you by your laser sales rep.  You must understand that everything is negotiable.  Do not accept a 1 year warranty, ask for a 3 year warranty.  If they are not negotiable on the price, then ask for a “DEMO” unit.  Demo is normally code word for a discounted price.  In most cases, demo units are not even used pieces of equipment, but it allows the manufacturer to legitimately sell you a new piece of equipment at a much lower price while maintaining their price integrity.

Regarding clinic build out, my recommendation is to find a medspa location that is already built out.  There are hundreds of medspas that have gone out of business.  In most cases they have ALREADY spent HUGE bucks to create a beautiful facility.  They have already spent the big bucks for tenant improvement.  You can pick these built-out locations for FREE.  Don’t invest this money yourself.  Find a realtor in your city who specializes in renting medical office space along with retail space.  He should have a good lay of the land on what is available.  You will be surprised with what gem locations are available.

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