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For Physicians In Cosmetic MedicineMedical Spa MD is the premier physician community for dermatologists, plastic surgeons and clinicians practicing in skin clinics, laser centers, and medspas with thousands of physician members around the world. Why should you join Medical Spa MD? Learn More > Join Now For Instant Access To Members Only Content & Downloads. It's free!

Five Tips to Maximize the Value of Your Medical Spa Practice

Maximizing the value of your medical spa.

Guest post by Dr. Lee Laris, Medical Director and Chief Cosmetic Surgeon at Phoenix Skin Medical Surgical Group in Phoenix, Arizona.

Would you like to improve the value of your medical spa practice? We’ll share simple tips to get the ball rolling: Here are Five Tips for Improving Medical Spa Practices:

1. Cut Through The Clutter – there’s an avalanche of information regarding ways to better one’s medical spa, especially by general practitioners. The truth however, is that each practice has its own set of rules that are relevant to improving profit margins and patient satisfaction.

A cosmetic surgeon who you befriended during general medicine training may’ve had phenomenal success – by adding just about every gem of cosmetic surgery on the planet to its menu of services. In a medical spa, however, this rule may not apply. It’s therefore important to discern what’s good and bad – and relevant to a medical spa’s niche.

2. Get Acquainted with Accounting – if you want to run a lean-mean medical spa machine, get familiar with numbers – fast.

Even though you’re in the business of medicine, it overlaps with the business of business. As a B2C company, an appraiser will explore several areas when assessing the business’ value, including monies, business model and how marketing is being conducted. By learning each area firsthand, you’ll know where to plug the loopholes, and add more value to what’s already being done.

3. Divide And Conquer – from the get-go, improving the business’ value may seem like an overwhelming feat. You’ve managed to build a tidy empire thus far, but how can new changes be applied, without disrupting the day-day-business, or affecting the quality of care?

Project managers are available to discuss the application of value add-ons, including name changes or new pricing strategies. One very important agreement to compose with a lawyer would be a non-compete contract, to eliminate the risk of current staff starting a replicated version of the medial spa.

4. Exit Strategy – once there’s value added to the medical spa, and a certified appraiser is able to confirm a substantial increase in the growth and revenue of the medical spa, application of the exit strategy will be in effect.

The exit strategy should be composed well before the implementation of the plan, and some suggestions include using the perfect timing. Just as how it’s easier to get a job while on a job, most medical spas will sell for faster and higher when it’s currently a booming one. An accountant or lawyer can help.

5. Legal Ties – it goes without saying that running a medical spa practice takes hard work and dedication. Still, if there are no legal contracts in place for employers, business partners and patients, the practice will likely succumb to a fall. Don’t allow this to happen. Consult and retain a top-notch lawyer to periodically review old contracts and scheme up new ones. The laws are furthermore changeable, so it’s essential to keep up.

The Benefits of Implementing Strategies

  • Legacy – for years to come, most medical spas will bear the same name, since this is what patients will be accustomed to. Though nothing is guaranteed, chances are that owners can pass on a legacy in their name, and one that was built from the ground up.
  • Client Retention and References – while you’re busy working to add value to the practice, customers will be busy booking appointments due to the quality of services. Customer retention and referencing also lowers the advertising budget, and eventually return customers will make up a large part of the business income.
  • Higher Profit Margins – value add-ons means making more, during the ownership of the practice, and ultimately when an offer for sale is made.

There’s always room for improvement in any practice – including medical spas. If this is your passion, and you’d like to ardently grow, seeking out the most effective ways to upgrade is the way to go.

About: Dr. Lee Laris graduated from Gannon University in 1981 and continued his education at the College of Osteopathic Medicine of the Pacific where he received his Medical Degree in 1987. His internship was completed at Grandview Hospital in Dayton, Ohio.

Dr. Laris is Board Certified in Hair Transplantation and Dermatology and is a member of the American Osteopathic Association, The Arizona Osteopathic Medical Association, The Osteopathic Physicians and Surgeons Association of California and the American Osteopathic College of Dermatology.


Collective Health: Replacing Insurance With Software

Technology startups are starting to make inroads and affecting (in a small way) some of the biggest players in healthcare.

One startup, Collective Health, began when one of the founders broke his foot. Instead of choosing to got the regular rout for an MRI that would have cost him $3,700 with a $1,500 deductible, he paid just $600 cash that day without going to his insurance provider. That transaction gave Ali Daib the idea for Collective Health, a new employer health program that recently launched with the promise to take the paperwork and time-sucking hassles out of health insurance.

Diab and co-cofounder Dr. Rajaie Batniji, a physician and political economist at Stanford University, paint Collective Health as a way to cut out the middleman (health insurance) and instead offer employers a less expensive, cloud-based, a la cart version of health care coverage for their workers. Employers can pick and choose which things they want covered for their employees.

Click to read more ...


Charging A $500 Fine For Leaving A Bad Review Online? Don't Try It.

Online reviews are problematic for a lot of medical spas, dermatologists and plastic surgeons, but trying to stime opinions is not the way to go.

You may have some negative reviews somewhere, but it can devistate your business if you try and implement anything that smacks of manipulation or bias... just ask the Union Stree Guest House.

This buisiness implemented a policy of trying to fine customers $500 for any negative reviews that they (or any members of their party) posted online.

Hundreds of people took to Yelp to compalin and write fake negative reviews that immediately raised the ranking and effectively took over the top rankings when searching for the business.... not what you want.

Yelp removed the majority since they weren't 'first hand' reviews but the damage was done.

Making any attempt to try and prevent your patients or clients from talking about their experience or voicing their opinions is both bad policy, and unenforceable.

Screen shots that were taken of the website showing the policy, which has now been removed, read "there will be a $500 fine that will be deducted from your deposit for every negative review of USGH placed on any Internet site by anyone in your party and/or attending your wedding or event."

From a story about this on CNN: Yelp reviewer posted complaints about the policy last year after he posted a negative Yelp review. "The management of this hotel had the gall to email us twice to threaten us financially about the negative review!" wrote one reviewer, whose Yelp handle is Rabih Z.

He continues: "Here is an excerpt from their first email: 'please note that your recent on-line review of our Inn will cost the wedding party that left us a deposit $500. This money be charged via the deposit they have left us unless/until it is removed. Any other or future reviews will also be charged to the wedding party (bride & groom) from the guarantee they have provided us.'"

Other parts of the hotel's website are a little cranky, too. One example: "We reserve the right to cancel a reservation at any time for any reason." Another policy about cancellations: "If your stay is longer than 3 days we do not accept cancellations of any kind."

Negative reviews are going to cost you revenue and impact your business, but trying to censor or stimie people online is only going to backfire and in the worst cases can really put you behind the eight-ball. The answer is to have your patients raving about your care and services.


Negotiating Work Contracts As An Aesthetic Physician

We receive requests information or advice from physicians, many of them looking to partner with other doctors or businesses in some way. 

Here's one we received this week that has also been posted in the medspa forums:

I am in talks with a fellow physician to be hired as an employee of (an existing aesthetic) practice. He is going to spend time training me (in addition to the training I already did with American Academy of Aesthetic Medicine) for a period that they say can be from anywhere between 3-6 months. Is that considered to be a long time to be trained? After they were comfortable with me doing different procedures I would then be seeing patients on my own.

Although they were advertising this job they keep asking me how much I want to be payed for both the training period and then after. I'm not even sure what would even be considered appropriate. Hourly? Salary? Percentage of revenue? They also are asking me to sign a 3-5 year contract.  Is this reasonable? This job is in (withheld) to give you any needed geographic references. I would appreciate any help that you guys could offer...

There is always a lot of confusion about this but most questions can really be divided into tow camps:

  • What is the fairest method or structure for compensation? (The business question) or
  • What is the best legal structure for medical oversight or liability? (The medical/legal question.)

The legal structure is always going to depend upon location since every state or country is different. In some states you can provide medical oversight legally even if you're not on-site, in others you have to physicially be at the location when any treatment is performed that you're extending your medical oversight to, and there are some states where a physician has to actually perform the same treatments that estheticians' are allowed to perform pretty much on their own. Countries differ even more with some treatments (laser hair removal is one example) being classified as medical treaments in some countries and not others. That being said, it's pretty easy to find out what your requirements are based on whatever location you're operating in.

The compensation issue is much less straightforward and can actually be impacted by some of the legal strictures that your location imposes. A couple of issues that might be of concern for you:

  • Direct referrals from other physicians may be seen as fee-splitting. (Fee-splitting is designed to prevent physicians from getting kick-backs for sending patients to other physicians.)
  • Non-physicians can not employ physicians in the US. (There are corporate relationships that are used effectively to get around this.)
  • Who is providing the medical liscence and oversight?
  • Who is providing malpractice insurance and has the legal liability?
  • Where/how is revenue being generated?

You can see that these issues all compound and none of them are trivial, but these business decisions and negotiations are much more clearly defined since every business deals with them. They're basically defined by the market and what it will bear. I'll post some thoughts later on all of these questions one by one and we'll work through the list.



How Your Competitors Might Be Destroying Your Medical Spa Business Using Google Maps

Almost anyone can damage your medical practice business or reputation by turning Google against you.. and it's not very hard.

medical spa google maps

Here's an example from Wired Magazine detailing how a restaurant's business was destroyed: Read the article.

It began in early 2012, when he experienced a sudden 75 percent drop off in customers on the weekend, the time he normally did most of his business. The slump continued for months, for no apparent reason. Bertagna’s profits plummeted, he was forced to lay off some of his staff, and he struggled to understand what was happening. Only later did Bertagna come to suspect that he was the victim of a gaping vulnerability that made his Google listings open to manipulation.

He was alerted to that possibility when one of his regulars phoned the restaurant. “A customer called me and said, ‘Why are you closed on Saturday, Sunday and Monday? What’s going on?’” Bertagna says.

It turned out that Google Places, the search giant’s vast business directory, was misreporting the Serbian Crown’s hours. Anyone Googling Serbian Crown, or plugging it into Google Maps, was told incorrectly that the restaurant was closed on the weekends, Bertagna says. For a destination restaurant with no walk-in traffic, that was a fatal problem.

In the case above the business owner is actually trying to sue Google, claiming that a competitor manipulated the restaurants business and that Google didin't do anything about it.

He's not going to get anywhere with that, but it serves to highlight just how vulnerable a local business can be if you're not keeping abreast of what's going on.

Beneath its slick interface and crystal clear GPS-enabled vision of the world, Google Maps roils with local rivalries, score-settling, and deception. Maps are dotted with thousands of spam business listings for nonexistent locksmiths and plumbers. Legitimate businesses sometimes see their listings hijacked by competitors or cloned into a duplicate with a different phone number or website...

Small businesses are the usual targets. In a typical case in 2010, Buffalo-based Barbara Oliver & Co Jewelry saw its Google Maps listing changed to “permanently closed” at the exact same time that it was flooded with fake and highly unfavorable customer reviews.

“We narrowed it down as to who it was. It was another jeweler who had tampered with it,” says Barbara Oliver, the owner. “The bottom line was the jeweler put five-star reviews on his Google reviews, and he slammed me and three other local jewelers, all within a couple of days.”

The first thing you should do is go to Google, Yelp, Yahoo, and Bing and search for your business in different ways using your street address, name, zip code and your name (with misspellings if that's possible) and see what the returned results are. That should give you a sense of whether or not you might have an issue. All of the search engines have a method for creating a local business listing and changing it once you have it.

Not addressing new technology is really just whistling past the grave yard. Your business and reputation are vulnerable and makeing sure that you have clean information online is the first step.


TruClinc Finally Brings A Real Telemedicine Solution For Concierge & Cosmetic Clinics

Telemedicine for small (cosmetic and concierge clinics) is finally getting off of the ground with TruClinic.

Very different from the doc-in-a-box model of other telemedicine players, TruClinic is the first truly embedded technology that closely fits how providers already work, and increases the ability of both physicians and physician-extenders to see more patients.

TruClinic has been built into a full telemedicine platform with a knack for tackling hard integrations, bottom-up user growth, and jaw-dropping uses. TruClinic’s cloud-based portal gives providders and patients access to each other from anywhere. All they need is a computing device, Internet connection, and a webcam, smart phone or tablet. From remotely wiring every home on the Goshute Reservation to facilitating interactions between a mother and her newborn child in an ICU to hosting surgical followup appointments, the uses of an always on, instantly connected telemedicine platform are only starting to be realized.

TruClinic is already being used actively by both small individual physician clinics, and larger hospital and clinic chains like the University of Utah Health Care that serves 5 surroundings states in a referral area encompassing more than 10 percent of the continental US and where TruClinc helps the U to reach their clients better, particularly in fields that mostly require communication, like mental health or post-surgery follow-up.

The University of Utah Health Care System is a thought leader in telemedicine. Here's a video:

One of the places that this is likely to be addopted first by individual physicians is around concierge or cosmetic medicine, where a very high-touch interaction at a distance can really have an effect on an ability to scale and interact with more patients in the same amount of time drives real revenue.

You can request a demo of TruClinic here.


Just When You Thought You'd Seen It All.

Bagel heads? What the hell?

National Geographic's new television series Taboo has shed light on the bizarre Japanese trend for “bagel heads”. Japan is the locus of weird. Especially in places like Tokyo, where you're compacted in with millions of other people, if you want to look like an individual the standards are HIGH.

Supposedly, the increasingly popular procedure is done by injecting saline into the forehead, then pressing in the center of the swollen area with a thumb. It’s temporary, so your “bagel” absorbs into your body after 6 to 24 hours, and that’s a good thing – no bagel-headed grandmas will be walking around in 50 years.

I can't see that you need to run out and sign up for any training on how to do this...


Dr. Hung William Song - Omni Aesthetics in Oakland, New Jersey

Oakland, New Jersey Cosmetic Physician Dr. Hung William

Name: Hung William Song, MD
Clinic: Omni Aesthetics
Location: Oakland, NJ

Can you tell us a little bit of your background and how did you get to where you are now? 

I am board certified in internal medicine I practiced internal medicine for 15 years but switched to a 100% cosmetic practice in 2008. I had about a two year transition period when I did both, but eventually turned over all my medical patients to a colleague and started concentrating full time on my cosmetic practice.

Do you have any procedures that you like better than others? Have you dropped any treatments? If so, why?

My favorite treatments are dermal fillers and fat transfers. I stopped marketing acne treatment because acne is more of a medical problem rather than cosmetic, I now refer these clients to a dermatologist.

You offer treatments with fat transfer. Where have you seen the most success with this treatment? What have you learned about getting the most benefit from this? Do you have any special techniques or 'tricks' that you use? 

I offer a full face fat transfer. I like to fill the whole face starting from the hair line and temples to cheeks, nasal labial folds and pre-jowel sulcus. I use the Viafill system and mix platelet rich plasma with the fat for better viability.

Can you share your experience with fat transfer? How would you describe the efficacy and results? Where have been the most successful improvements in keeping the fat alive after transfer?

By using a disposable coated cannula to harvest and inject the fat and mixing the fat with PRP, I have been able to get good uniform fat retention. The fat is centrifuged using the Viafill system.

What are your thoughts about the technologies you’re using now such as Smart Lipo and Ulthera? 

Smartlipo is a good system because it is a very recognized name, but the machine is very expensive with high disposable costs. If I was to do it again, I would have bought the Vaser for half the price.

Ulthera was a moneymaker for me the first two years but now, I am having a difficult time with competition undercutting me on price. Everyone seems to have one these days including the gym across the street. The consumable cost on the Ulthera is also very very high.

I recently purchased the THermiRF system. This one was a home run because the price of the device is very reasonable and the consumable cost is very low. I use this device for stand alone skin tightening and in conjunction with doing liposuction on small areas like face, neck and arms. It is a very versatile machine but it does require some minor surgical skills which his good for me because I don’t think they will be offering this at the gym across the street.

Click to read more ...


Limiting Options Can Boost Your Medical Spas Sales

When you're trying to be everything to every one, too many options will actually cost you.

We make choices daily, may it be major or minor. We desire choices which we can differentiate and evaluate. But presenting individuals an abundance of choices do not necessarily equate to happier consumers. Consequentially, if you happen to be providing your medical spas clients or patients with too much choices, it will almost always hurt your conversion rates.

Choices have repercussions on the brain. As a matter of fact, some studies revealed that having to come up with a lot of decisions can leave people exhausted, mentally drained and more dissatisfied with their decisions. On top of that, it leads people to commit poorer choices -- sometimes at a time when the choice is crucial. Even if we choose well, we are often less content because, with so many choices, consumers are certain that somewhere out there was something much better. We experience doubt and uncertainty about the alternatives and we ponder about missed opportunities.

The same is applicable to your clinic. Your lits of services and pricing should be simple, straightforward and uncomplicated. If you want to increase form conversions, you must think about eliminating the number of options, not continually increase them. An easy experience shows users that you have enough options to choose from, and allows them to make comparisons that are relatively easy.

In fact, offering fewer options quickly lead to many more profits:


  • You're able to spend your patient markeing budget on fewer items.
  • Your staff can spend less time trying to talk about everything you can do, and talk about the benefits of the things that you already do.
  • You probably don't have to buy more technology.
  • Your patients can make clearer choices, and feel better about their decisions.
  • You sound more credibile and 'expert' in the area.


Limiting your menu of services and focusin your offering on a few key offerings gives you many benefits, and few drawbacks. If you offer everything you'll never be seen as being an expert in anything.


Awesome Plastic Surgery Commercial?

Rhett & Link make local commercials (and they've turned their attention to plastic surgery).

These guys have millions of views on their YouTube channel. In these videos they show a 'behind the scenes' making of and then the actual videos.
You have to give it to Dr. Timothy Kelley there... that's not what you normally see, but the proofs in the 621k+ views... something's working there.

The Beauty and the Buzz at ASLMS

Just like many of you, my day is scheduled from morning to night and I am lucky if I can grab a bite to eat in between patients. It’s a real challenge to carve out time for professional development (and lunch). That’s why I appreciate the annual conferences hosted by the professional organizations. I can block out that time months in advance knowing that I will come back with new ideas.  

The American Society for Laser Medicine & Surgery (ASLMS) is on my must attend list year after year. It’s probably the best in the world for exchanging ideas and real science in the world of aesthetics, and not just marketing hype.

This year was no different. The 2014 meeting held in Phoenix, AZ was full of ideas. So many ideas that I wish I had a longer flight home to research them all.

When I returned my staff asked “What was the highlight”? The truth is there were so many highlights. I came home with so many pearls of wisdom about so many different areas of practice. I’d like to share a few of them with you.

Privacy Laws    
This year brings changes in HIPAA privacy and security rules. There are new rules addressing the sale of protected health information for marketing and fund raising purposes. There are new rules surrounding business associates that you contract with. There are also new waves of audits to ensure compliance. The meeting was a call to action to get my staff prepared for the new guidelines.
Under Eye Bags
For those of you not familiar with Neotensil, I suggest you take a look. It is a new film-like substance, made by a hair care line Living Proof, which reduces the appearance of undereye bags. It’s sold through physicians’ offices, but applied by the patient at home.  
Injectable Filler Technique
Take that extra care, that extra wipe step, with Voluma and other facial fillers. When injecting fillers in the hollows of the lateral orbit, think microcannulas with a lateral point temple zygomatic point of entry.  And on those crow’s feet, think of almost individual dosing per severity of lines at those two to three lateral orbit injection points. I also learned about pre-injection disinfecting wipe pads that combine clorhexidine with isopropyl alcohol.
Acne Suppression
There was a lot of buzz about keeping acne at bay using combinations of both short pulsed and long pulsed YAG lasers. It seems a paradox, but patients did better long term when they did laser acne treatments after finishing a course of antibiotics.  For patients with unresponsive rosacea pustular acne, think SIBO or small intestinal bacterial overgrowth and order a lactulose breath test screen.  
For that post treatment unintended or inconvenient bruise, think of speeding up its disappearing act with an IPL treatment about 2 days after.  
Tattoo Removal
Here is a tip for tattoo removal for those of you not yet into Picosecond lasers. Treat the area through a hydrocolloid dressing, such as Second Skin.  
Noninvasive Fat Removal
There was a ton of chatter, all of it exciting, about noninvasive fat removal. The players are CoolSculpting,  Liposonix and the newest kid on the block, Vanquish.

Some of the above ideas are reality for me. We added Vanquish to our list of noninvasive fat removal a few months back. It’s a great fit for our practice and patients. Other ideas may not be a fit. But that’s the beauty of the meeting. With so many new products and protocols shared in one space, you are bound to come back with ideas to push your practice forward.  


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