We have helped a lot of Docs set up MediSpas. We have seen some pretty big blunders as well as some great successes. When we are called in to "rescue" a practice we are often mystified by the issues:- Take for example the guy who did not understand why it was a problem for his high-strung dog to run around the practice and "poop" if he did not get his way. Is that the MediSpa experience you are looking for? Nor us.
- At the other end of the spectrum are poor equipment choices. Sure you can buy an IPL that will claim to do everything you need in just one unit. You might even get that for say 70K. But as we have seen many times, you will not get the results claimed and you will have many unhappy customers. This is no way to grow a practice.
- Yet another problem is the use of ultra-specific equipment that can do only one type of treatment. Unfortunately, that leads to fitting the patient to the treatment you can perform, rather than the other way around.A problem with cost is not recognizing the per-patient cost of the treatments you are interested in giving. As an example, if you purchase a laser with the laser-head in your hand piece you can expect to replace it more often than one that is better protected in the laser box. Not only is the "laser in the hand piece" more susceptible to being dropped etc, it has bigger issues with cooling, thus shortening its life expectancy. If the laser you purchase requires a new "treatment head" for each new patient, you can expect that to add up quickly as well. If you buy a laser that is slow, you will have the added cost of time for each treatment. All of these issues have an impact on the bottom line.So 'this' laser costs 100K and 'that' one costs 120K. Which should I buy? I often hear this question. Unfortunately, this is not even the right question. The right question is: "what is the true cost of ownership?" Some lasers have poor cooling systems and you need to replace parts more often. Others are not made with the "real world" in mind and have high operator damage (ie: laser head in your hand and not in the box). Others have high per-patient cost or parts that wear out (think Fractional treatment heads or IPL filters)What you should look for...Look for a versatile system that can perform several procedures but is not a "jack-of-all-trades master-of-none". You need a piece of equipment that can deliver an extended set of treatments at published parameters, under safe conditions and in a fast and economical manner.On the non-ablative side, one of the great work horse lasers of Aesthetic Medicine is the Nd:YAG. But not all Nd:YAG's are created equal. With the proper machine, this wavelength can do all of your hair removal, spider-veins, collagen remodeling (skin tightening), active acne, wart treatments and fungus treatments. With the right models, the Nd:YAG can also do lipolysis and endo-venous therapy for varicose veins. For a laser to have this kind of versatility you need to look for one with energy feed back control, auto calibration and variable square pulsing. These are the features that will allow the laser to be flexible enough to do all of these treatments.On the ablative side is the Er:YAG laser. This wavelength is the most versatile of the three major ablative lasers. Because of its high absorption in water it can be used in a "cold ablation mode." In addition, with a variable pulse width it can be made to function more CO2 like, resulting in more heat deposition. It can also be used in a pure heat mode. Because of this versatility, the Er:YAG laser can be used in a wide variety of treatments. It is used for all ablative therapies, including pigments, wrinkles, acne scaring, benign mole removal and solar damage, skin resurfacing and other applications. It can be used in both full resurfacing and in fractional resurfacing modes. Again, to get this level of versatility you will need a laser with high power, energy feedback control, self calibration and variable square pulsing.With just the two lasers described above, one is able to give most of the treatments that one sees on the various talk shows or reads about in magazines. An additional benefit of these lasers, if properly configured, is they will have very low operating costs. The costs of operation are low because there will be little in the way of consumables. Sure you could break a fiber or drop an optical (not laser) hand piece, but by in large the lasers are built to last. The consumables that one uses on patients are 4 X 4 gauze pads and isopropyl alcohol - things that cost very little.One additional laser that may be of use is a Q-Switched laser. A Q-Switched laser is one with a very short pulse duration, generally in the microsecond range. These lasers are used for pigment changes, skin rejuvenation, birthmark and tattoo removal. To be effective, these lasers need to have a very high power rating. They will also need multiple wavelengths if used for tattoo removal. It is possible to find quite versatile machines with 4 wavelengths that can manage most tattoo colors and give excellent results for pigment removal and skin tightening. A very good choice in this regard is an Nd:YAG / KTP Q-Switched laser with 585 nm and 650 nm hand pieces. This will give good coverage for tattoo inks. The Nd:YAG will cover black brown and dark blue. The KTP will cover red, orange and purple. The 585 is good for sky blue and some yellows. The 650 covers green and some yellows.It is important to have a high-powered Q-Switched laser because high powers are needed to break up pigments, whether they are tattoo pigments, age spots or the dyschromia of vitiligo.When I lecture I often have docs come up to me and tell me about the 8 or 12 lasers they have in their office. They feel they need all of these to do the various treatments they offer. I can't imagine the kind of overhead that results in. With the three lasers above you can do it all. But remember not all lasers are created equal. You will need to find the right lasers. They will need to be self-calibrating, have energy feedback control and be capable of variable square pulsing. Once you have a versatile set of lasers, you can move forward knowing that if it's doable you can do it.
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