How the Mighty Fall ... BusinessWeek May 25, 2009

Hey Fanny Boy

Is anyone else having trouble with Fraxel and Melasma? I have seen a number of melasma patients worsen with Fraxel Treatments. I have stopped using Fraxel for Melasma!

I use it for melasma all the time but I ALWAYS haver the patient use the obagi NuDerm system at the same time. I have had excellent results. I have the Fraxel SR750 and do 10 to 12 joules and 2000 to 3000 mtz/cm2.

LH,

I have problems specifically with asians, southern italians and south americans. How is it working in your skin types 4 and 5? We use Obagi as well. Melasma almost always comes back. Are you finding this to be true and how are you managing expectations?

someone needs to charge these pricks with " practicing medicine without a license" they always say "we dont recommend this or that", I always laugh and say " who cares what you recommend haha ha.... you are not a doctor you are just a laser seller you dont know what your talking about! I cant even stand talking to them i send my medical assistant to meet them.
They are not worth my time. remember doctors talk to doctors and sales people talk to office manager. they are at that intellectual level! its our own fault for giving them the podium. remember residency! the chief resident doesnt talk to the intern!! interns talk to interns. so if they want doctors at as an audience then they should have a doctor coming by to talk to the doctor. we are stupid if we listen to them. it would be like listening the cosmetologist behind the makeup counter that tells people how to treat acne!

Mohamed Kheiralla

Do not spend a fortune buying expensive laser machines with consumable tips. You will have a difficult time recovering your investment. You will encounter PIH from skin Type IV and type V patients no matter what type of resurfacing or fractionated resurfacing you do if your patients encounter daily sun exposure. Always use some type of hydroquinone topical products before and after your do any resurfacing procedures and ask your patients to wear surgical masks in the day time for 7-10 days after each resurfacing treatment when they go out door.

As far as laser machines goes. The korean lasers Sellas, Lutronics, Mixto are all big players in asia. Don't know if they offer support in Cairo. One problem with the less expensive laser equipments is that the machine often do not recalibrate after each start up. Unless you have sales reps who do regular maintenance on these machines, you will not know the actual out put (Joules) of these lasers from the hand piece and that from the machine setting.

I would recommend you to buy a good IPL device and a good Q switched 1064/532 ND Yag Laser. This is pretty much all you need to get started. The Sciton Profile is a great platform so is the Lumenis One platform. Get a dependable Q switched ND YAG laser machine such as Hoya C6 or Medlite or Fotona 1064/532 . This is pretty much all you need.

It takes a long time to make money off any laser platform due to high initial purchasing cost and monthly maintenance costs. Injectable fillers and Botox treatments are more profitable.

It is exciting to see a young doc entering the practice. Wish you much success. Will definitely come by and say hello if I get a chance to visit Cairo Egypt (a beautiful city) one day.