Many of our clients want something for fat reduction, cellulite, and/or skin tightening. I have heard many of the things out there are not predictable and results vary greatly. Any suggestions for what seems to work best, keep customers happy as well as coming back. We are building clientele, establishing trust and loyalty and the last thing we want is to chase the cash without delivering results. I do not want a bunch of unhappy patients. We currently offer nothing for these problems.

Wait about 6 months. There a lot of predictable technologies coming to market and we should see the fallout.

Endermology, Triactive and the others stink. They are not long term answers. Lipodissolve and meso are inexpensive to learn and start. They work in general but if you have a client that doesn't watch what she eats etc it is not going to do much. the patient needs to be on board.

We are being 'encouraged' by Dermacare Corporate to use the SmartLipo. We haven't gotten an edict yet, but the buzz seems to be it will be a necessary piece of the puzzle soon. The docs I have spoken with so far like it (not the reference list docs, but real in-the-trenches guys). It is really hard to find objective data and reviews out there.

The convention for the franchisees is in May. I would expect part of it is going to be sponsored by Cynosure since a lot of us are a little annoyed with Cutera lately. Reliability issues and reps nowhere to be found except with a new technology pitch. I would also expect Carl Mudd to appear behind bullet-proof glass like the Pope.

He'll probably show up drunk. I heard he got a DUI last year.

LH,

Are these new technologies going to be somewhat affodable or leaseable if they are equipment? I've been told to watch for Alma's laser which is not FDA approved yet but is being used in Canada. Anyone know anything about this company and thier equipment?

They will likely range form $60,000 to $150,000. I do not think the Alma is going to be comparible to the others technologies although I am not sure of what alma unit you are talking about.

These are completely new technologies. I would assume that all of these will be leaseable.

The IPL of the ALMA laser is okay. The rest is junk.

Also of note, Thermage is developing a fat/cellulite tip for the NXT.

I am a practitioner who has used Thermage for 3.5 years. I was initially, like most practitioners extremely disappointed with the results which saw only about a 30% satisfaction rate for patients. The issues with subcutaneous fat loss occurred as a consequence of practitioners desperately looking for ways to improve the success rates. Little guidance was provided by the company. Clearly the technology when originally introduced was not ready for prime time. Over the years, the number of pulses progressively increased so that effectively now the number of pulses is about 4x the number that originally was used producing a satsifaction rate in excess of 85-90% when the patient has been properly educated about what it is that thermage can do and to make sure that only patients with mild to moderate skin laxity are treated since more than that will require multiple sessions of thermage that will be prohibitively expensive. The company's response was clearly inappropriate and harmful to its own best interest. When it became clear from experimentation in the field that progressively more pulses were needed the company just charged for the extra pulses without making proper allowances for the extra cost and time necessary to do the procedure. The attitude became predatory on the practitioners which created the vacuum which resulted in competition for producing both refurbished Thermage tips as well as consumables. The company attempted to aggressively intimidate its practioners whenever necessary to reprogram their machines to disallow the use of any refurbished tips by threatening law suits. However, as a result of this reasonable challenge in the market place Thermage eventually has now lowered the cost of these tips to help accommodate the need for additional pulses as well as to increase the size of the treatment tips and now more recently the refractory time between pulses that helps to speed up treatment time. The current cost of tips is now only about $100 more for a 600 pulse tip for the 3.0 cm2 size than for the refurbished tip. Previously it was twice the cost. It is my feeling that Thermage treatment does a good job in properly selected patients if adequate pulses are applied which for a full face is probably 1200-1500 pulses. Unfortunately, Thermage only makes a maximum pulse tip of 900 which requires the purchase of an extra 300 pulse tip for about $300, the cost of which cannot easily be charged back to the patient since the standard cost of the treatment of $3,500 in most areas is about as much as the market will tolerate. If you have an older machine, do not permit Thermage to reprogram your machine to disallow the use of the refurbished tips since its just such a threat that unfortunately seems necessary to keep these predators at bay.

Regarding the issues of pain, I give all my patients 150-200 mg oral demerol or the equivalent prior to the procedure. I want them to feel a little loopy. That way I can turn up the energy levels and get a better result. The procedure is supposed to be uncomfortable but tolerable. If they are clenching their fists, grinding their teeth and curling their toes, then you just turn the energy down. Regardless, excessive pain is avoidable. For some people, I determine the energy levels that they require based on pain threshold and then to make the procedure more comfortable, I will use these levels on all areas of the face but use a local block such as 2% lidocaine in those areas that seem excessively sensitive. But it is critically important that you determine a patient's energy tolerance before doing this. Otherwise you might be tempted to use excessive energy levels because they can't give you any feedback that might either burn the skin or produce subcutaneous fat loss because the energy may have gone too deep.

Off face applications such as the stomach and arms and legs are impractical due to the excessive time that is necessary to cover these areas with the current tips along with the excessive cost of additional tips. If the company would reduce the cost of the tips, which they won't significantly enough, then some of these areas could then be addressed.

What the company should have done was to create a 1200 pulse tip for the current 600 pulse price with a time limit on it set to prevent excessive use on other patients and the practitioner advised to use as many pulses as seems necessary up to a maximum of 1200. Otherwise, the practitioner will be tempted to use less pulses in order to save cost and consequently achieve a lesser desired result which ultimately is not in anyone's best interest including that of the short sighted company that manufactures them.

What settings with the various tips do you feel you need to be at to get good results?

Comment on the "Smartlipo" machine above: a randomized trial of smartlipo vs. standard lipo - published in the Plastics journal within the past year - showed few, if any significant differences. Personally, it doesn't seem to be worth the investment.

You might want to look into the CoolLipo from Ccooltouch. It is a 1320nm machine which has proven to provide a level of skin tightening and is considerably more powerful than the 1064nm Smartlipo. Cooltouch was also issued a US patent a few months ago to treat cellulite with this device, but I don't of results on that front. One thing is for sure, you will get a better deal on the CoolLipo, I just talk to a doc that was quoted $140K for the new 10w machine from Cynosure.

Dr. Doug Key in Portland has had great results melting fat and tightening skin and I think will be speaking at some of the upcoming conferences.

I would definitely look at the CoolLipo and also the Sciton ProLipo is coming. The advantage to the ProLipo you can use it for endovenous work as well. I am not sure about the CoolLipo.

LH-What do you think of Sciton's SkinTyte? Do you use it much?

I do not use it a lot. We use it more as an add on at this time but will likely start marketing it more in the future. If anyone else has used it much please let us know what you are seeing for results.

LH we have had it for 3 mos and it will take about 3 Tx's to equal 1 Thermage (IMHO); But we package this as a "360" where we do tightening, IPL and a Erbium on top, Usually people need 3 txs so its no big stretch to do this (and w/ no "disposable" cost w/ w the Sciton)

I am using it for skin tightening for 6 months now with very good results.I agree that there is need for 3 txs with 1 month intervals but it is not painful even in 55J/cm.

Thanks for the input. I want to get more aggressive with marketing the skintyte but I always want to know what to expect. What kind of results are you seeing with the skintyte,BBL and erbium? Are you doing them the same day? How deep are you going with the erbium?

LH yes we are doing all three the same day w/ good results and minimal downtime. We do the Erbium at 6-10 microns; 20 microns or more seems to take a week + to heal.

Do you think the Skintyte and BBL extend the healing time of the microlaser peel? I have done a number of BBL followed by a 50 micron peel and it does seem to extend the healing time a bit.

Yes LH it does seem to delay healing w/ all three; but, when you think of it, you've got healing on multiple levels of the skin so intuitively it makes sense fo a longer "heal" time. Great post..made me think!

I would like to do all 3 but do a deeper peel to 50 or 75 microns. I wonder if this would be to much trauma to the skin and possibly cause delayed hypopigmentation as occurs with the CO2. I have not seen any papers on this. The big question is how deep is safe.

I bet you would see very nice results with a series of 3.

LH the CoolLipo is also available with the endovenous option as well. The issue that will plague the ProLipo, like Smartlipo, is that it's a 1064nm and the market is starting to understand the limitations of 1064nm for this procedure. My guess is they will eventually come out with a 1320nm lipolysis device.

Actually, the ProLipo is 1319 (Scitons is a 1319 not 1320) not 1064. There still is no consensus on which of the 2 wavelengths is the best choice. I have been looking for research papers on the true difference on lipolysis from the 1064 and 1320. I have not had much luck. All of the papers are produced by docs on the pockets of the laser companies.

I got a quote of 95,000 for the 6W machine and 125,000 for the 10 from Smart Lipo. At the time I talked to Cool Touch their machine was 10k lower than Smart Lipo and S. L. was 87,000 then. Isn't this called "price gouging"? I told the Smart Lipo rep I was no longer interested at his quote today of $125,000. I would wait until another company came up with the technology. Also, he told me that Cool Touch didn't have any patent on their machine and that I would be liable if I bought it.

I was just at a conference and talked to a SmartLipo rep and I am confused. I have heard ranges of $110,000 to $140,000 for the SmartLipo. The rep at the conference told me that the list price for the SmartLipo is $118,000 for the 10watt machine. He also told me that they have room to move so do not pay the MSRP. They know they have competition coming that will be FDA approved.

What laser assisted lipo system is everyone using?
I understand that SmartLipo is the only one currently FDA approved at this time which will be changing in the immediate future, however, I would believe that Dr's, here, have used the ProLipo and CoolLipo off label in clinical study settings...What have been your results?

JL,

I know for sure that the prolipo is FDA approved. I am not sure about the coollipo. The only wavelength that is FDA approved is the 1064 but if you talk to most docs that are doing laser lipolysis they feel the 1320 may be a better wavelength. I assume that one of the companies is going after the 1320 for approval from the FDA.

We haven't added laser lipo yet, but I know that Cynosure and Sciton 1064 are approved. There are no FDA approved 1319 laser lipo systems cleared for the actual use of liposuction yet. The only 1319 systems pending FDA approvals are Cooltouch and Sciton.

Dexter

I would like to clarify somethings about these laser assisted devices mentioned on this posting. CoolLipo by CoolTouch is a 1320nm device, currently FDA pending. The adventadge of 1320 is that it does a much better job of "tissue tightening" than a 1064nm. I believe the 1320 device is seeking FDA aprroval for this additional feature.I believe CoolTouch recently combined the CoolLipo 1320 with their endovenous 1320 component into one machine.
One major problem with the original SmartLipo was that it was too weak output wise.

One more thing about CoolLipo that I am waiting for before purchasing it instead of the SmartLipo is they are going to come out with a laserfiber so small that can "lipolyze" and "tighten" the eyebags or "tear trough". I believe this is a big advantage also.

pmdoc,

Thanks for the info. I have been waiting as well to purchase. I had not heard about the eye fat pad lipolysis. I was hopeful that this would soon follow. My guess is that all of them will have the ability to work on the eyes. I hope they get the FDA approval for the 1320 soon for laser lipolysis. I would prefer to purchase the laser with only 1320 and not have to purchase the 1320 with the 1064.

As of now, you can only advertise laser lipolysis with the 1064. So some docs are using the 1320 fiber first and then switching to the 1064 so they can legally say they are doing laser lipolysis.

Add Ultra Shape to the mix. Im waiting to see if they will receive FDA approval for "08". It really looks like a great solution for non-invasive body contouring. Uses ultrasound hence no discomfort. Of course the question with all this new technology....does it really work.

Anybody on the board doing SmartLipo. Interested in results and what wattage machine you have. Apparently they started with 6 watt, then moved to 10watt, and now claim to offer (only to facilities with Plastic Surgeon on board) an 18 watt machine.

I would be cautious regarding CoolLipo, it does not have FDA for laser assisted lipolysis and no peer reviewed clinical data. I would also take the SharpMed comments with a grain of salt since I just learned he is the CoolLipo Distributor in the MidAtlantic region.

Actually the CoolLipo is pending FDA approval at this time. I have looked into the Ultrashape but is not that impressed by it, due to its prohibitive cost, cumbersome handpiece and time consuming procedure. It would be interesting to see what would come out from Liposonix or Ulthera down the "ultrasound pipeline"

Apparently, the Cool-lipo device has received its FDA approval. Supposedly (according to the patent information), the wavelength was chosen for its "skin tightening" ability, and not its "fat-melting" ability.

I'm not yet clear on how this would be superior to standard lipo combined with external laser treatments....any opinions? It would seem difficult to apply the energy evenly to the area through a fibre from the underside.

Sciton is working on getting the 1319nm OK'd for laser lipolysis. Many feel it is a better wavelength for both lipolysis and skin tightening. They have already gotten the 1064 approval from the FDA. I am waiting at this time in hopes of purchasing just the 1319 wavelength.

50-75 micron MLP's - LH - how do you accomplish these comfortably?

I use a compounded 23% lidocaine with 7% prilocaine it works well. If I am going much deeper I will start doing blocks as well. Be cautious as you do not want toxicity.

Thanks, LH.

Which compounding pharmacy do you use? How long of an application? If you'd like to email me instead, it's maxamme at the google mail service (gmail.com)

I appreciate your advice. I've had the Profile for about 18 months now, and feel like I'm not using it to its full potential.

LH please let me know the information regarding the 23% lido and 7% prilocaine combination.

Thanks,
Anitha

Bought the Coollipo and it works well. Pacific Northwest rep is very helpful and accomodating to me. Company is a joy to work with. People coming out of the woodwork to hear about the treatment and love what they are seeing. Price is no option. Very happy with my purchase. I am glad I passed on the Smartlipo.

I've too heard that the Coollipo is now FDA approved and so now is doing the best job of laser lipolysis AND skin tightening. This is apparently the reason that the other laser companies are making a 1319 (or 1320). I think companies are "reaching" to get their 1064 lasers to offer more procedures... The Coollipo company has been making this wavelength for skin tightening for many years. We use to use one with our IPL many years ago for more tightening, and it works!

kc and MDAesthetics,

Sorry, it is 23% lidocaine and 7% tetracaine. I misspoke when I said prilocaine. We get it from Central Avenue Pharmacy in Pacific Grove, CA. Telephone is 800-501-9715.

There is the new Pliaglis which forms a mask but costs about $60/treatment. I am not going to pay that much for it.