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Medical Spa Design for Wellness and Safe Space Amid COVID-19 and Beyond

Posted By Administration, Wednesday, July 8, 2020

design rendering

By Michele Pelafas, ASID, IIDA, Michele Pelafas, Inc.

The past few months of sheltering in place has taught us a lot about space and what matters, and about luxury and priority. The new luxury is wellness and safe space, and you must respond to this with a meaningful, thoughtful and safe patient experience. This will also determine how you succeed in the future.

As businesses continue to re-open, government mandates now play a significant role. It is essential that these requirements be adhered to. In the meantime, be careful not to throw dollars at “fixes” that may or may not make a difference in the long run. This is the time to plan for the future; it is also an opportunity to redefine your brand. The following four design imperatives will serve as a foundation for the betterment of your employees, clients and business.


Although six-foot centers are the new norm, we cannot underestimate the benefit of utilizing every inch of space. But dollars are not built on space alone—revenue can be cultivated by positive patient experiences, results and retail sales, to name a few. Once the mandates for social distancing are removed, and when it is safe, you can create a sense of distance. Even if your IV therapy chairs are set up on 54-inch centers, there are ways to create an open feeling while enhancing privacy.

First, consider implementing a minimalist design to create a medical spa that feels clean and not overcrowded. Minimalism is in. At the least, unclutter your space by removing décor off the reception desk, beverage counters and other areas; this will allow for easy cleaning and provide a feeling of space. You can open up your medical spas with lighter neutral hues on the walls. You can also use cleanable commercial-grade wall coverings and reflective materials that create depth.

Consider flow for safety and privacy, such as separate intake and outtake areas. Multipurpose rooms allow for flexibility and different revenue opportunities. Make retail part of the patient journey. Implement smaller retail areas throughout the spa, including in treatment rooms.


Now more than ever, we think of home as the safest place on earth. Your patients will be looking for that same feeling at your medical spa. Comfort is a feeling and a state of mind. Drawing inspiration from residential spaces makes perfect sense. Safety equals security and security equals comfort. Everything and anything that you can do to make your patients feel comfortable is essential.

Consider updating your space with elements that engage the senses. Think about soft but cleanable textures. Integrate relaxing scents, soothing music, comfortable commercial-grade seating and warm lighting; this will promote a sense of calm, relaxation and the feeling of home. The medical spa of the future will be a sanctuary—warm, friendly, inviting and personal. At the same time, future medical spas will be built with state-of-the-art materials that are productive and promote cleanliness. The new medical spa must balance “sterile-type” applications with the feeling of tranquility.

Although comfort is a feeling and a state of mind, perception and reality are different. For example, a sneeze-guard between a guest and the receptionist can be a reminder of good hygiene, and it can also help prevent the transmission of airborne germs. However, it cannot, for example, prevent an infected patron from transferring germs to a door handle. Deep cleaning every moment of every day is essential. If you do not follow the basic guidelines for sanitation and cleanliness, the sense of security will be short-lived. This could be detrimental to the guest, the worker and your business. Add a sneeze-guard if you must, but don’t let it be a barrier between you and what matters.


Most of us understand wellness as eating right, exercising and practicing meditation, but wellness plays a role in our surroundings, and it is very important. You need well-built interiors for the well-being of your patients, guests and employees. Because of COVID-19, we are hyper-focused on prevention and preparedness. This will continue to play out in the medical spa.

Research shows a correlation between our health and interiors. The links between art, aesthetics and well-being are well-known. Other factors, such as adequate daylight and views to nature, play a role; so do colors, acoustics, indoor air quality, ergonomics, scents and more. Consider everything, from ventilation to lighting. The well-built environment is multi-faceted and a movement.

As part of the well-built interior, there should be honest dialogue between you and your patients. You should ask customers how they physically feel. Staff should have protective gear, such as masks and gloves. Without question, you must clean and disinfect. Well-focused interiors include policies, procedures and training. All these initiatives are driven by mandates you should follow. This will help prevent the spread of any virus, and it will provide you with a safe, healthy environment.


I practice the art of quality over quantity, and always have. Quality has more meaning. Quality saves you time, money and energy. Quality has more depth. Quality also typically brings you better results. When planning for the future, you must consider why quality matters. Because of COVID-19, there is a case for quality over quantity. It has more implications than ever before in the medical spa environment.

Quality first impressions are important. You have a short window to establish trust and communicate your value. You must establish a sense of order, beauty, calm and efficiency. You can accomplish this with harmony and balance. Repetition of color, shapes and brand image will also help. Consistency is connected to reliability. All this builds confidence and integrity.

Quality design matters. It will strengthen your brand and set the tone for a safe medical spa experience. Through design, you can create a caring and orderly structure. This leads to a sense of safety, responsibility and loyalty. It gives the impression that your business knows what it is doing. Quality design includes touchless faucets and wipable surfaces. Access to hand-wash stations instill confidence, peace and calm.

Quality surfaces are impervious and easy to clean. Consider quartz, stainless steel, porcelain and plastic laminate. Some of these materials are inherently antimicrobial; antimicrobial protection helps to kill microorganisms or stop their growth. Copper is another natural antimicrobial surface, and it offers a beautiful patina over time. Semiprecious stone—agate, tiger-eye and petrified wood, for example—is stain and scratch-resistant, and resistant to bacteria. Semiprecious stone surfaces are beautiful, though pricey. Bamboo has an antifungal agent living in it. Cork stops bacteria and microorganisms from growing. Consider flooring that has very few joints, such as luxury vinyl, epoxy or terrazzo; this makes the floor very easy to clean.

On a final note, quality doesn’t have to be expensive. You can do more with less, which is the whole point—less is truly more. You need to utilize your budget dollars wisely. Invest in ideas that will yield the biggest returns. You cannot go wrong with investing in these imperatives. Space, comfort, wellness and quality all lend themselves to a safe and secure environment. They will set the foundation for your successful business.

Click here to enter the Michele Pelafas, Inc. Sponsored Giveaway to win a free 60-minute Design Strategy Session!

Michele Pelafas, Inc. is a leading design firm in the medical spa, beauty and spa industry. Its clients include spas, wellness centers, medical spas, hotels spas, salons and fitness centers. Michele Pelafas, Inc. provides professional design consultation and strategic interior planning while integrating custom manufacturing and whole spa equipment to owners, operators and consultants across the U.S. and abroad. Its principal and founder, designer Michele Pelafas, has more than 22 years of experience with hundreds of projects in her portfolio, including award-winning designs. She is an educator and expert in the design field, a frequent speaker at industry trade shows and featured in industry trade publications.

Tags:  Business and Financials  COVID-19  Med Spa Trends 

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The Science and Art of Hyaluronic Acid (HA) Dermal Filler Injections

Posted By Administration, Monday, July 6, 2020

hyaluronic acid injection

By Leslie Baumann, MD, and Paula Purpera, PA-C

Dermal filler injections using hyaluronic acid (HA) are among the most common noninvasive cosmetic procedures performed today. There are many different varieties of HA filler on the market, so it is important to understand the differences in the various fillers so that you can choose the best option for patients. HA fillers usually are safe, but can cause serious complications, especially when not used properly; most complications are reversible when recognized and treated early.

HA is a naturally occurring sugar that binds 1,000 times its volume in water. It gives volume to the skin and helps with cell-to-cell communication. In its unmodified (uncrosslinked) form, natural HA has a half-life of approximately 24 hours before it is enzymatically broken down by hyaluronidase and metabolized in the liver.

This article will briefly discuss the features that differentiate the various HA fillers on the U.S. market.

HA Concentration

Fillers with high concentrations of HA have more volume, viscosity and stiffness/firmness, as well as longer duration compared with the exact same HA with a lower concentration. Theoretically, the higher the concentration of HA in the filler, the stiffer it is and the longer it will last. Fillers are labelled as having a certain amount of mg/mL of HA in them; this number includes crosslinked and uncrosslinked HA. Only crosslinked HA contributes to duration of the filler, because uncrosslinked HA degrades in approximately 24 hours. Uncrosslinked HA often is added to dermal fillers to make extrusion from the syringe easier and smoother. Although the concentration of HA in a dermal filler is important, other factors also come into play when considering longevity, including the amount of crosslinking, viscosity/spreadability, stiffness and cohesivity.


HA is quickly degraded by the naturally occurring enzyme hyaluronidase. In order to increase longevity, HA is chemically modified and “crosslinked” to form a hydrogel. A higher percentage of crosslinks leads to a firmer product, increased longevity and decreased flexibility.

Chemical crosslinks bind the strands of HA together, but not all crosslinks are complete. As seen in the figure, complete crosslinks bind at least two different HA chains, while incomplete crosslinks—also called pendant crosslinks because they look like a pendant on a necklace—are only attached to one chain. Pendant crosslinks provide less stability and duration than complete crosslinks. There is no way for the practitioner to know how many of the crosslinks are complete versus incomplete; therefore, when a package insert says a product is 11% crosslinked, that information can be misleading.

G Prime or Elastic Modulus

The stiffness, or G’ (G prime) of a product is a measurement of gel hardness. It defines the gel’s total resistance to deformation, or the amount of stress required to produce a given amount of deformation. It is measured by placing the gel on a plate and then placing a second plate over it and applying lateral force. The higher the G’ of a product is, the firmer it is. The elastic modulus, as well as other factors, such as cohesivity of the product, determine the appropriate product placement of the HA filler. For example, gels with higher G’, such as Restylane Lyft, are stiffer and are able to resist dynamic facial movements. These products may provide better lift and should be used in deeper lines, such as the nasolabial folds, melomental folds, and for lifting the lateral brows, or correcting the nasal bridge and tip. Low G’ products, such as Juvederm Volbella, typically are used in areas that require a softer product, such as the lips, the tear trough, or fine lines and superficial wrinkles.


Complex viscosity (ŋ) is defined as resistance to flow. Crosslinked HA is more viscous than native HA, and a product with higher complex viscosity does not spread easily. A product with lower viscosity has a greater ability to flow and spread in the tissue. Ideally, a spreadable product is required in large areas that need to feel soft, such as the cheeks.


Cohesivity relates to the force between the particles of the material that enables it to stick to itself. This defines the property of the gel to spread (low cohesivity) or remain intact in the tissue (high cohesivity) as it is injected. Along with viscosity, this allows for the HA filler to be easily moldable after injection without fragmentation of the gel.

Ease of Extrusion

Extrusion force is important, because the force with which the HA leaves the syringe can affect bruising and the risk of tissue damage and vascular occlusion. Syringe design, the addition of uncrosslinked HA to the filler, the needle gauge used and the amount of pressure placed on the plunger by the aesthetic provider all affect extrusion force.


Bruising and swelling are common complications of HA dermal filler injections. Having the patient avoid NSAIDS, aspirin, salmon, green tea, vitamin E and other anticoagulants for 10 days prior to injection can decrease the risk of bruising. Using the proper pre- and post-procedure skin care also can decrease bruising and swelling. Using a lighter extrusion force, avoiding vessels, using a careful massage technique, and warning patients to avoid heat, stress and exercise for 48 hours after the procedure can help minimize complications.

The following are serious complications that can result from filler injections.  You must know how to handle each of these before injecting patients:

Vascular occlusion. Vascular compromise is the most serious complication associated with dermal filler injections. Arterial occlusion can result from direct embolization of filler material into an artery that presents immediately as skin blanching and pain. If left untreated, this can lead to deep tissue loss due to necrosis or, worse, vision loss. Venous occlusion, on the other hand, may be caused by large volumes of filler injected into a small area. This can present as prolonged pain and swelling with a dark discoloration. Vascular compromise can be prevented by knowing facial anatomy and proper injection depth, as well as using a slower injection technique with minimal pressure; small boluses also are recommended. Treatment consists of hyaluronidase injections, warm compresses, massage and applying nitroglycerin paste to the affected area.

Delayed nodule formation. Delayed nodules appear as non-fluctuant lumps under the skin, usually in either the dermis or the subcutaneous space. These may present several weeks to months after injections, and may be caused by infection or an autoimmune response. These nodules are very troubling and can be disfiguring to patients.

Some nodules are caused by bacterial collections that secrete polymers, creating a biofilm over the injected material, and cause them to irreversibly adhere to the product. This biofilm not only creates an inflammatory nodule, but can also release bacteria in the surrounding tissues, causing an infection or another inflammatory nodule. This can be avoided by employing aseptic technique during injections, as well as a thorough review of patient medical history.

Some nodules are caused by activation of the immune system. We are not certain why this occurs. Therefore, never inject patients with a HA filler if they have received vaccinations in the previous two weeks. Many doctors believe this may increase the chance of a delayed type hypersensitivity reaction. Management of these nodules exceeds the scope of this article.

Angioedema. Some patients may develop an IgE-mediated hypersensitivity to the injected fillers. This is characterized by swelling, erythema, pain and itching that is seen in an allergic reaction. This usually presents within an hour of injection, but can persist for weeks. Angioedema typically resolves with antihistamines, but recalcitrant cases may need to be treated with oral prednisone. Rapidly progressing angioedema must be closely monitored, as it can lead to an airway obstruction.

The Art of Injecting

Many injectors follow mathematical guidelines and use the same injection techniques for every patient. Adhering to the Golden Rule or the Divine Proportion of 1:1.618 during cosmetic injections imparts harmony and beauty to the aging face, but it is imperative that patient consultation and treatment be as customized as possible. Knowledge of facial anatomy is crucial for safety purposes and improved aesthetic outcomes, but patient assessment in an artistic manner is paramount for increased patient satisfaction. Gender differences in anatomy and ideal face shape must be considered, as must concordance with the rest of the facial features.

Managing patient expectations with realistic endpoints is key to patient satisfaction. Having a written pre- and post-procedure skin care regimen augments the effectiveness of dermal filler injections and ensures patient compliance. Monitoring progress and outcomes using standardized photos is key.


With the rapid increase in popularity of filler injections, extensive understanding of dermal fillers is fundamental for any aesthetic injector. For optimal results, aesthetic providers and injectors need to have a thorough understanding of facial anatomy, have in-depth knowledge of dermal filler rheology, and be able to avoid, recognize and manage potential complications.

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, contact us online or call us at 312-981-0993.

Leslie Baumann, MD, FAAD, is board-certified dermatologist, researcher and author. She was director of the Division of Cosmetic Dermatology at the University of Miami from 1997–2006. Her clinical trial research has been instrumental in the U.S. Food and Drug Administration (FDA) approval of Botox, Dysport, Jeauveau, Kybella, Voluma, Sculptra, Juvéderm, Restylane Silk, UltraShape Power, Ulthera and other aesthetic treatments. Baumann authors a twice-monthly column for the Miami Herald newspaper and a monthly column on cosmeceutical ingredients in Dermatology News. She holds four patents on methods to improve the skin’s health and appearance.

Paula Purpera, MSHS, PA-C, is a cosmetic dermatology PA based in Miami, Florida. She specializes in anti-aging and acne skincare, as well as laser use in dermatology. She is an expert in platelet-rich plasma injections and microneedling for skin rejuvenation, hair restoration and improvement of scars and stretch marks. Purpera is an Allergan Master Injector and serves as a trainer and lecturer regarding cosmetic injection techniques and other cosmetic procedures. She is a published author and has three pending textbook chapters on cosmetic dermatology.

Tags:  Clinical  Med Spa Trends  QP 

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The Logistical and Financial Benefits of MSOs

Posted By Administration, Wednesday, July 1, 2020

handshake agreement

By Ben Hernandez, Skytale Group

For most current or aspiring medical spa owners, legal considerations are the primary reason for contemplating a management service organization (MSO). In most states, medical procedures must be performed by physicians or physician-owned organizations. Therefore, for a non-doctor to own or take part in a medical spa, an MSO must be set up. This allows the clinical aspects of a medical spa to be owned by and overseen by a doctor, while the non-clinical aspects can be performed by non-doctors (the MSO entity).

Beyond legal considerations, however, are there any benefits in setting up your organization as an MSO? The answer is a resounding “yes.” Allowing non-doctors to participate in the medical spa industry attracts talent that may otherwise not be available to a medical spa. Also, setting up a MSO creates a potential to scale and find efficiencies in processes and cost. Finally, setting up a MSO helps promote interest from investors, such as private equity groups (PEGs).

Non-doctor Talent

Setting up an MSO allows medical and administrative separation. While the “S” in MSO stands for “service,” you also can think of the “S” as “support.” In a medical spa, it’s difficult for a doctor to be responsible for billing, training and marketing on top of all of the clinical work. A MSO model allows a management company to bring in talented, experienced people to carry out administrative and business responsibilities. This allows the doctor to focus on the patients.

A management services agreement (MSA) will ultimately dictate the responsibilities for the management company—they may include human resources (HR), accounting, finance, marketing and billing. For example, a bookkeeper or head of finance should be able to determine and execute on the flow of funds that take place between the management company entity and the clinical entity. They should provide the clinic with accurate books, forecasted financials two to three years out, and cash flow to ensure any capital expenditure plans are accounted for. The doctor and owners should have a clear picture as to how they are performing.

The MSO creates clear responsibilities like these in order to attract people with talent and experience to complement the doctor’s clinical experience. Organizations set up this way from the beginning have the potential to operate far more efficiently and are more capable of scaling.

Potential to Scale

Once you have a MSO structure and your team is in place, adding more medical spas to your MSO becomes more streamlined and cost-effective. Depending on the size and number of medical spas, this can mean anything from a couple locations sharing one bookkeeper to 10 clinics being supported by one HR team, one IT team, one marketing team, one call center and one training team. Depending on size, these are functions you can centralize or outsource to third parties until you are large enough to bring them in-house.

As this takes place, the unit cost for each individual hired by the management company lessens. This also has an inverse cost relationship with suppliers and vendors, translating to lower costs for expenses such as clinical supplies, office supplies and finance. As this transformation takes place, your organization, at a clinical level, can continue to focus more on its patients than it previously did. This improvement in efficiencies, effectiveness and knowledge of your space and patients, in turn, attracts outside investment from larger MSOs to PEGs.

Interest from PEGs

We can look at the history of industries, such as medicine, veterinary and dental to predict what will continue to happen in the medical spa space. These industries have transformed. Before, the landscape was extremely fragmented. Over time, they started consolidating because of operational and cost efficiencies. These spaces are each at different consolidation life cycles—for example, medical is far more consolidated than dental, although dental is catching up—but all are going through it.

PEGs typically pay a multiple based on earnings before interest, taxation, depreciation and amortization (EBITDA). Depending on what you want in your exit, this is another intriguing aspect of the MSO model. PEGs are interested in everything from how much growth is still left in your organization to what risk profile your organization has from a regulatory standpoint to what your secret sauce or recipe for success is.

A one-location practice with a $350,000 EBITDA, for example, may sell for a three-times multiple, while a 10-location practice with a $4 million EBITDA may go for a ten-times multiple. Other factors that may be considered include:

  • How much growth is still left in your organization? Is the PEG buying an organization that has matured and, therefore, is already paying for all the growth? Or is it buying an organization that is growing by double-digits and plans to continue to do so over the next few years? At this level, you should have three-, five- and 10-year plans as to where the organization is going next and should have future financial forecasts tying that vision to the numbers.
  • What is your organization’s risk profile? Legal compliance is part of the reason for starting an MSO in the first place. Has your organization taken the proper steps to ensure all legal and regulatory requirements are being met? Added risk will have an adverse effect and potentially even cause PEGs to back off.
  • What is your secret sauce and recipe for success? This will come to light, as it is a combination of how you have performed in the past and your plans for the future for continued growth and success. Is your model a de novo model, an acquisition model or a hybrid? Can you present to PEGs you have a clear vision and approach to each? Is your focus in a specific city, state or region? Within that focus, is your market urban, suburban or both? Is your target patient 35 to 54 years old, or are you starting to see opportunity and growth in the 18-to-34 segment? How are you reaching both? How are you able to attract and retain key team members, from doctors to C-suite at the management level?

Starting a MSO may have first entered your mind as a legal must, but as you execute on the model, know that it can potentially also open an exciting journey to future team members, growth and, eventually, partners.

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, contact us online or call us at 312-981-0993.

Ben Hernandez is a partner at Skytale Group who specializes in strategic management consulting for various service industries. He also offers his clients corporate-level financial analysis and guidance. As a co-founder of Skytale Group, Hernandez is passionate about leading an organization that people are proud to work with. He serves his clients not only with years of experience and service industry expertise, but also through upholding the Skytale core values of integrity, excellence, teamwork and fun. He loves to help small business owners achieve their dreams, aspirations and visions. Previously, Hernandez has worked with an international investment banking group, a financial services and advisory institution, a hedge fund, and CPA and advisory firms.

Tags:  Business and Financials  QP 

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Cosmetic Dermatology Photography: Lighting, Backgrounds, Shadows and More

Posted By Administration, Monday, June 29, 2020


By Scott Alten, RxPhoto

Professional-level patient photography is fundamental to the success of aesthetic clinics. For providers of cosmetic dermatological services where incremental or subtle improvements in skin need to be accurately and concisely captured, documenting basic changes and improvements is insufficient—client images must be sharp and polished. Effective photographs can offer your practice a range of benefits, such as:

  • Treatment planning;
  • Documentation of facial and anatomical features;
  • Pre- and post-procedural comparisons; and
  • Teaching and education.

Fortunately, today’s mobile devices (smartphones, tablets, etc.) offer quality that is comparable to that of a professional-level DSLR camera, but they are much easier to use. As a result, more and more service providers are capturing patient photographs with their mobile devices, allowing flexibility with respect to where the patient is photographed. If you want to learn more about DSLR cameras in comparison to mobile devices with regard to plastic surgery photography, you can weigh up the benefits and disadvantages here.

One critical issue to be aware of, however, is observing HIPAA compliance if you are using a mobile device to take client photographs. The simplest way to ensure that you are HIPAA compliant is to use a service that stores photos in a HIPAA-compliant cloud server for you. This way, photographs taken are automatically stored on the cloud but never on the device itself. Read more here about achieving HIPAA compliance in your clinic.

The Critical Importance of Lighting in Your Exam Room

The importance of consistent, bright illumination and an evenly lit space cannot be emphasized enough. The lighting in client photographs must be maintained to ensure uniformity, particularly if you are capturing images prior to and following procedures. Inconsistent lighting can veil or obscure treatment progress.

The effect of outside light. Although the photographic quality and capacity of the new generation of mobile phones and devices is outstanding, there is one thing they cannot control: the lighting in a room. This is immensely affected by the natural light outside, and the intensity of the natural light changes between the morning and afternoon. Colors fluctuate and appear warmer in the early morning or late afternoon light due to the low angle of the sun.

If you photograph a patient in the morning, and their next photo is taken in the afternoon, the photographs will be significantly different, impacting on the uniformity of the images. There are three ways to maintain consistency in photographs despite changes in outside light.

  • Be scrupulously consistent in the times you photograph. However, this is not always realistic or feasible with busy schedules and clients who require flexibility in their appointment times.
  • Convert a windowless room in your office into a dedicated photography room, thus eliminating any alterations in natural light that will affect the photograph. However, in a busy office with high movement of patients, there could be logistical issues with multiple clients requiring photographs at the same time.
  • Purchase a blackout shade. For minimal investment, blackout shades provide maximum return. Blackout shades create conditions that mimic a photography studio by providing maximum light blockage and consistent lighting. Each consulting room can easily be fitted with blackout shades, thus creating multiple rooms suited to taking patient photographs.

Сolor temperature. Color is measured in units called degrees Kelvin (K) and is integral to achieving successful and consistent lighting. Lightbulbs that produce yellow, ambient light have a color temperature of around 2700 K. While perfect for landscape photographs, this is unsuitable for clinical photographs, as it gives the subject warm overtones and distorts the skin tone.

As color temperature increases from 3,000 K, the color of the light appears yellow and whiter. Temperatures over 6,000 K are referred to as cool colors; the photograph will appear to have a bluish-white tinge. The color temperature of daylight varies, but it is often in the 5,000- – 7,000-K range.

A color temperature of 5,000 K is ideal for medical photography as it gives the perception of daylight with white light, capturing subtleties and details in the photograph with clarity.

Setting up optimal lighting. Excellent, studio-quality lighting does not happen by chance. The best photographs are products of careful manipulation and consideration of light sources to achieve a well-illuminated image. Lighting can come from five main light sources:

  1. Overhead lights. If you rely on overhead lighting in your clinic as your main light source, be aware of the degree of Kelvins of your light bulbs. (You will need a color temperature of 5,000 K or more.) Also, endeavor to have a light fitting that broadly disseminates light: The broader the light source, the more even the light illumination, which helpfully fills in shadows. Also, be aware that the closer the light source, the softer the light. Photograph patients as close as possible to the source of overhead light. The closer the patient is photographed to a light, the broader the light source in relation to the subject, and the patient’s features will be well-illuminated. Consequently, the further the patient is from the overhead light, the dimmer the light in the photo will be. However, overhead lighting is paradoxical in that the proximity to the light source also increases the likelihood of shadows occurring. The light is brightest on the upper aspects of the person’s head, which creates shadows under the nose and chin as the light falls over the face. Balancing these two variables can be challenging, and for this reason, having an additional source of light or lights on the patient is invaluable: It will eradicate shadows and brighten the image. Read below to find out more about auxiliary or supplementary sources of light.
  2. Speedlights. Speedlights are larger light units that can be used to flood the photograph with even white light, which is ideal for clinical photographs. Speedlights provide both an enhanced and a more abundant source of light in your photographs, providing the quality of light you would expect to find in a professional studio. Speedlights can be easily synchronized to your smartphone for straightforward use (see here). Speedlights are best used in conjunction with diffusers to help make the light appear softer and more natural in the image.
  3. Ring lights. Ring lights are photographic tools commonly used for portrait photography that disseminate uniform light (in a ring shape) from the camera. A flash tube is wrapped around the camera lens. A ring light is an excellent way to achieve even light in images and eliminate shadows, particularly for photographs where the face or skin is being captured. These days, ring lights are incredibly popular because they can be easily fixed to your smartphone and can dramatically improve the quality of lighting with minimal fuss. They also can be used with a diffuser to soften the light as it is emitted from the flash.
  4. The flash. Using the flash on your device can overexpose and flush images with bright light, muting subtler details on the skin, such as fine lines and blemishes, or variations in skin color and tone. If you need to capture photographs for facial rejuvenation or resurfacing procedures, it is best to avoid using a direct flash when taking the photo. Soft, diffuse and even lighting will allow you to capture facial redness and pigmentation. In most cases, the flash should be used as a last resort, used only for dark corners or if specific lighting is really needed in a particular area.
  5. Soft boxes/diffusers. Soft boxes diffuse the flash of a ring light or speedlight, converting the harsh light from the flash into a broader, softer, more even light. Furthermore, soft boxes reduce shadows. Unfortunately, soft boxes are not appropriate to use with overhead light sources, and they can take up space.

Setting Up Your Space to Achieve the Perfect Lighting

Setting up your space to achieve the right lighting is paramount. The ideal setup to photograph a subject should include the following:

  • A blue, grey or black backdrop. (See notes on selecting the perfect background below);
  • A position marked on the floor, or a floor mat for the client to stand on; and
  • The device set up directly in front of the subject; you can use a portable stand to fix the position of your smartphone or tablet.

With respect to additional lighting, there are two options.

  1. Soft boxes, diffuser and flash; and
  2. Ring light.
    1. Attach a ring light to the device. Ring lights offer the quickest and most space-effective method of achieving well-lit images with minimal fuss. Ideally, the light source should be stationed parallel to the subject at the level of the face to flush the photograph uniformly with light.
    2. If using a speedlight rather than a ring light, it is best to use it with a diffuser so the light disseminated is softened.

ring light

Using an Appropriate Backdrop for Your Photos

If you want to improve the professionalism and focus of any clinical photo, investment in a good quality backdrop can offer incommensurate gains. The background of your photographs should be:

  • An even surface;
  • Neutral;
  • Non-reflecting (for example, shiny oil-based wall paint provokes reflections in flashes); and
  • Monochromatic, or one consistent color—ideally black, grey or blue.

Sheets or drapes are inappropriate as backdrops, as the undulations in the fabric show wrinkles and shadows, detracting from the photograph. The use of different backgrounds in photos is a common issue that severely affects photo quality: Photographing a client in front of a laser or the wallpaper of the exam room shifts the focus from the patient and the clinical image to the background, which will often also cast irregular shadows.

Standardized backgrounds are simply more professional and more effective, and they guarantee uniformity in your photographs. Most digital cameras use a computer weighting system that will focus partially on the subject and partially on the wall behind them, blending the distances and focusing on neither. A neutral background places the camera’s focus squarely on the patient.

You can purchase white or light blue panels or roll-down shades to fix to the back of the door or wall where you take your photographs of clients.

Another effective option is a collapsible chromakey background. Specifically designed for photography, this backdrop can be hung on the back of a door for when photos are being taken, and then neatly and easily stored away when you are not using it.

background information

Background colors. The three most appropriate and effective colors you can use for a backdrop are blue, black and gray. Here are the pros and cons of each:

color table

Eliminating Shadows

Shadows are caused by unevenly distributed light, and they can obstruct photos and detract from the focus. If you can see a shadow in the viewfinder, you can be assured there will be a shadow in the shot.

  • Check for shadows under the nose and neck and, if necessary, reposition the lights to eradicate them.
  • Check for shadows cast on the backdrop—if there are shadows, these can often be eliminated by moving the subject further away from the backdrop. Twelve inches of distance between the subject and the backdrop is recommended to minimize these shadows occurring.

The use of an additional flash unit with your smartphone or tablet can cause a tremendous improvement to the lighting and the quality of the photographs you take if your office has dark corners, shadows or a lack of natural light. Used in conjunction with soft boxes, you can almost entirely eliminate any shadows, or at least dramatically minimize them.

Attention to Detail

Unsurprisingly, the small and seemingly inconsequential details also figure in successful clinical photography. Paying attention to the ways in which the patient’s hair, makeup and jewelry impact photographs will help ensure you achieve more standardized and competent images.

  • Hair should be tucked away or tied back in such a manner that no facial features are obscured. Any stray strands of hair need to be pinned away from the face or tucked behind the ears. Having some hair clips, ties or bobby pins on hand can be useful.
  • Makeup should be removed prior to the photograph, particularly for patients who have undergone dermatological procedures. Obviously, makeup will obscure any gains or improvements made as a result of laser resurfacing, microdermabrasion or skin rejuvenation treatments.
  • Jewelry can be distracting and detract from the focus of the photograph; it should be removed.
  • Garments or accessories such as brightly colored scarves that impact on the visibility of the area being photographed should also be removed prior to the patient’s photograph being taken. In addition, such pieces can affect the uniformity of images that show response to treatment over time. As much as possible, strive for consistency across the series of photographs that you take.


“Pixel” is a contraction of the term “picture element.” It is the smallest element of a digital image, as digital images are composed of tiny squares, similar to a tile mosaic on a kitchen wall. Although digital photographs appear to be smooth and continuous, they are, in fact, compositions of millions of tiny squares, or pixels.

A smartphone camera that boasts 10 megapixels means that each photograph has ten million tiny squares in it. As a result, an image of 10 megapixels will be more detailed and nuanced than a photograph of three megapixels, for example. The iPhone 7 has a sophisticated 12-megapixel camera, whereas the iPhone 6 has an 8-megapixel camera. The iPad Pro boasts a 12-megapixel camera, meaning that photographs of faces will be incredibly clear and detailed.

Purchasing a smartphone or tablet with an advanced camera can significantly improve the quality and sharpness of the photographs you take.

Mobile Device / Digital Zoom vs. DSLR / Optical Zoom

Mobile phones and devices are equipped with digital zoom. DSLR cameras, however, boast optical zoom, and optical zoom trumps digital zoom every time. Optical zoom uses a range of lenses to make it possible for the photographer to see an object in the distance as if it were closer. As these lenses are mechanically complex, they cannot be compacted to fit in a thin smartphone body.

Smartphones and devices are fitted with digital zoom, which is a zoom that blows the image up without actually focusing in or adding more detail. As a result, the image becomes blurrier and appears pixelated. For this reason, using zoom on a mobile device is inappropriate for taking medical photographs, as the quality and precision of the image is compromised. It is better to get closer to the subject to capture detail if necessary.

However, change is afoot: The iPhone 7 and iPhone 7 Plus have two lenses at different magnifications, allowing for some zoom with sharper images. This is not true optical zoom, but nevertheless a definite advance for digital cameras.


Capturing professional photographs of your clients requires measured consideration of the elements that will impact on the composition of your image.

For clinics that do not have the luxury of a dedicated photography room, the addition of several inexpensive tools can go a long way in improving your client images. Purchasing a collapsible chromakey background, blackout shades for windows and a ring light will dramatically improve the quality of your photographs.

It may take some effort in the beginning, but setting up your office space so it can quickly and effortlessly be transformed into a photography studio to accurately and consistently track your clients’ progress is an incredibly worthwhile investment that ultimately will serve to benefit you by improving your business.

Scott Alten is the managing partner of RxPhoto, a medical aesthetics software that helps providers capture standardized and consistent patient photos, go paperless with digital forms and notes, and showcase treatment results, which increases patient conversions and retention.

This post originally appeared on RxPhoto's website. 

Tags:  Guest Post  Med Spa Trends 

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Is the Future a Drive-Thru?

Posted By Administration, Friday, June 26, 2020

drive-thru medical service

By Patrick O’Brien, JD, legal coordinator, American Med Spa Association

Unless you have been living on a deserted island or in a remote mountain cave, you are well aware that the coronavirus pandemic has brought major and far-reaching changes to our daily lives. Medical spas and the aesthetic industry have not been immune to these changes. As businesses have been permitted to re-open, they have had to face new challenges brought by these circumstances. Some innovative practitioners have begun offering drive-thru injectable services to meet these issues. For these appointments, the patient completes their intake documents and initial screening remotely, and then is met by the practitioner in full personal protective equipment (PPE) in front of the spa for treatment. As some spas find success with this model, others are looking to expand the types of procedures they can offer. Will this become a medical spa mainstay or a curiosity of the times? No one knows for sure, but if you want to start offering services like this, there are a few issues you will want to consider.

What Are the Benefits?

Before we jump into the issues, let’s explore why you might want to consider this type of service. Even though many states and cities have lifted restrictions on business or stay-at-home requirements, many people are justifiably reluctant to venture out. Since COVID-19 spreads by aerosol and contact with an infected person, you can limit your risk of infection by limiting your interactions with people. Every doorknob you touch or room you stand in is a place where you can catch it. In this regard, in-car or drive-thru service is attractive to a patient because they don’t have to leave the safety of their vehicle and they have to interact with the minimum number of people. Due to this mentality, they are much more likely to use services that make them feel safer and are more convenient.

For medical spa practitioners and owners, drive-thru service is nice because it limits the number of people entering the office, thus reducing the need to sterilize rooms multiple times per day and shortening each appointment. (Ideally, rooms should be cleaned between every patient and at the beginning or end of each day.) It also limits the contact your employees have with potentially infectious patients. While you will still pre-screen and take other precautions for each patient, they only interact with one provider instead of several staff members; this has the side benefit of reducing your PPE costs. While each employee will still need to wear appropriate PPE in the office, the use of heightened PPE—such as gloves, gowns, eye protection and N95 respirators—can be limited to the one provider.

Is This Legal?

Generally speaking, most states do not restrict where a physician may practice, provided they are able to maintain the appropriate standard of care for their patients. Therefore, treating a person in their car would generally be permitted, provided it is done in a safe and clean way. There are a few states that have location-based restrictions on procedures, including Nevada, which limits the administration of Botox and other injectables to physician offices and other specified locations. We previously covered the topic of concierge or house-call medical aesthetics, which you can read here. Many of those issues would also apply to a drive-thru type of service.

While this is generally permitted for physicians, states will often have rules and requirements for non-physician providers and appropriate practice settings. These can run the gamut of complications from minor inconvenience to strict prohibition. On the one end, we see this in supervisor agreements for physician assistants (PAs) and advanced practice registered nurses (APRNs). Often, these agreements will need to authorize the settings in which they may practice. In this case, addressing the issue may be as simple as amending or executing a new agreement. On the other hand, the practice requirements for PAs, APRNs or registered nurses (RNs) may include specific approved practice locations, such as licensed facilities or clinics; they probably do not explicitly authorize a parking lot. If this is the case, contacting the medical or nursing board may be helpful in getting more information about what is allowed. And finally, as a reminder, you will need to adopt new office protocols to account for these types of services. Typically, nurses are required to practice under appropriate office protocols for the services they provide.

Just Because I Can, Should I?

Clearly, there is more to offering drive-thru treatments than just performing the treatment. But for the most part, the legal issues, policies, procedures and standard of care can all be met with some due diligence and groundwork. The benefits to patient satisfaction and safety certainly make it an attractive path.

However, there is one final concern that will need to be addressed before these services can truly be successful—public perception. You will notice that I have used “drive-thru” in this post. This is primarily because this is the phrase used in other media. Obviously, this is meant to create an implication that these treatments are the “fast food” of the medical aesthetic world, with the attendant implication that they are low-quality or cheap. This is similar to how medical spas were first viewed against traditional medical practices. Just as medical spas have gained legitimacy by providing high-quality services in a non-traditional setting, so will these new modes of service need to do the same. “Concierge,” “mobile” and in-vehicle services have the potential to provide high-quality and safe services in new settings, but they will need to convince the public of that. Food trucks have made the transformation from “roach coaches” to gourmet dining; we will see if in-car aesthetic care can do the same. The long-term success of these procedures will depend on medical spa owners and operators’ ability to navigate and overcome these challenges.

AmSpa offers resources (see here and here) that can help you re-open and get running again. We also have online training resources in our Virtual Boot Camp and our AmSpa Masters classes. Finally, on July 1, AmSpa will present a live webinar on re-opening, presented by Brad Adatto, founding partner with the law firm ByrdAdatto.

Tags:  COVID-19  Med Spa Law  Med Spa Trends 

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Shifting Your Sales Mindset

Posted By Administration, Wednesday, June 24, 2020

sales meeting

By Terri Ross, Terri Ross Consulting

When you hear the word “sales,” what immediately pops into your head? If you are like most people, words such as “pushy,” “slimy,” “smarmy,” “slick” and “aggressive” come to mind.

When I hear those comments from my clients, I’m always curious about what story they are telling themselves about the sales process.

I hear it all the time:

  • “I suck at selling.”
  • “I hate sales.”
  • “I dont want to feel pushy.”
  • “I’m terrible at sales. I’m a medical provider, not a salesperson.”

Sound familiar? If so, you are definitely not alone.

In fact, most clients I encounter have pretty strong limiting beliefs around sales. A limiting belief is an idea or concept that you accept about life, yourself, your world or the people in it that limits you in some way. A limiting belief is merely a thought we believe to be true.

As a high-performance sales coach, the first thing I do when working with clients who have limiting beliefs around sales is ask them a series of questions:

  • How true is that belief, really?
  • Where did you get that idea from?
  • What evidence do you have to support that belief?
  • How is it working for you? Has it affected your revenue or confidence?
  • What’s another way to look at it?
  • How willing are you to let that belief go and learn to master the art of sales?
  • How can you take an action step immediately?

Which Sales Mindset Best Describes You?

There are five general mindsets when it comes to sales. Every day and in every sales conversation or consultation, you have the power to choose which mindset you want to approach the sales process from.

The “I lose” mindset: The “I lose” mindset occurs when you feel you are at the mercy of certain events, limiting beliefs, emotions and perceptions that can hold you back from success.

Thoughts such as, “My sales pitch wasn’t good enough,” “I’m terrible at selling and converting, so what’s the point?” or, “Nobody ever buys from me, no matter what I do,” are common at this level. It is easy to avoid taking responsibility when you are in this mindset, as you are subscribing to an “it is what it is” way of thinking where your options seem limited. This mindset is directly correlated to the consultation process.

The “I win, you lose” mindset: This is the mindset of a lot of salespeople. They view the sale as a win, a conquest or a prize. It’s a “my way or the highway” type of black-and-white thinking. Some of the thoughts at this level are, “I can sell anything to anyone at any time,” “I’ll get them to buy no matter what,” “I need to convert this sale,” and, “It’s a dog-eat-dog world.” This is a person who will sell anything, even if it's not the right procedure or treatment, rather than turn someone away.

The “I’ll get them next time” mindset: This mindset involves rationalization, toleration and even a bit of manipulation. It involves thoughts such as, “It’s okay if they don’t book a service or procedure—I’ll get the next one,” “Maybe they didn’t have the money,” or, “I’ll try harder next time.” Also common with this mindset are thoughts such as, “It’s okay—I’m not a trained salesperson, I’m a doctor or a nurse, etc.” Sometimes, some manipulation and a bit of “graspy” energy comes into play, such as “What can I throw in to sweeten the deal?” Your only obligation as a provider is to educate, and when it comes from a place of value, you won’t question yourself.

The “giver/you win” mindset: This sales mindset differs a bit, as the practitioner is focused on the patient winning first and foremost, and it involves thoughts such as, “What can I give or throw in to make them happier or make their life better?” There is no manipulation with this mindset—more of a sense of, “How can I help the patient or make them happy?” Often with this mindset, practitioners give away too much time, throw in extra products or add on services that they would normally charge for.

The “win/win” mindset: With this sales mindset, there is a win/win mentality. You win, as you are able to convert a patient consultation into a paying service or create a long-term treatment plan to generate more revenue; your patient wins, as they are able to get the results they want and improve whatever issue or condition they come to see you about.

If you shift your mindset from selling to educating, you are simply providing additional opportunities to educate your prospective or current patients about what you offer and why they need it, and further cultivate the relationship and the “know, like and trust” factor. If you can approach your consultation from a place of detachment to the outcome of the result, you can focus on simply educating your patients on the benefits, results and solutions you offer, and stand firm on the costs involved.

So, which sales mindset do you find yourself most often identifying with? Remember, you get to choose how you would like to respond vs. react to the sales process.

My team at Terri Ross Consulting is here to help you master the art of sales, whether it is via a live sales training seminar, an onsite practice assessment, a high-performance sales coaching, or learning through my online sales training. Let us help you make sales your zone of genius as well, so patients can't wait to return.

Terri Ross brings more than 20 years of sales and management experience to the field, having worked with leading-edge medical device companies such as Zeltiq, Medicis, EMD Serono, Merck Schering Plough and Indigo Medical, a surgical division of Johnson.

Ross’ vast knowledge and experience as a sales director managing upwards of $20M in revenue and successful teams has allowed her to become a renowned plastic surgery management consultant helping aesthetic practices thrive.

To optimize revenues and business performance, Ross’ practice management consulting services help physicians evaluate practice processes including, but not limited to, overall-operating efficiencies, staff skill assessment, customer service and operating efficiency strategies. The goal is to develop a comprehensive plan of action to improve productivity, quality, efficiency and return on investment.

Tags:  Business and Financials  Terri Ross Consulting 

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Update: More Flexibility for PPP Loans

Posted By Administration, Monday, June 22, 2020

sba loan form

By Patrick O’Brien, JD, legal coordinator, American Med Spa Association

Earlier this month, Congress passed a new law, called the Paycheck Protection Program Flexibility Act, that is aimed at making it easier for borrowers to have their Paycheck Protection Program (PPP) loans forgiven. This past week, the U.S. Small Business Administration (SBA) and Department of the Treasury released amended rules and updated forms that reflect those changes. As we have covered in the past (see here), this program has already gone through constant refinement. The best place to keep up with the developments and see the latest documents on the PPP is at the Treasury’s Coronavirus Aid, Relief and Economic Security (CARES) Act webpage (see here).

We have covered details of the original PPP loans in webinars and articles, available here. This new law leaves the basic structure of the program but makes some critical changes that make these loans much easier to use. Originally, the PPP loans were issued in an amount equal to 2.5 months of a business’s average payroll expenses with a two-year term at 1% interest. Under the new law for all loans issued after June 5 (the effective date), the maturity is now five years; borrowers who have obtained loans before the June 5 can have their loans extended to five years by mutual agreement.

The primary attraction of the PPP loans is that money spent on payroll and other approved expenses during the first eight weeks is eligible to be forgiven. This window was found to be much too restrictive for many businesses who are still either wholly or partially shut down. The new law extends this forgiveness window to 24 weeks or December 31, whichever is earlier; borrowers for loans issued before June 5 can still choose to stay with the eight-week period. This extension has the side effect of also increasing the total amounts that can be paid to employees over the period; this was previously limited to $100,000 protracted for eight weeks. Of note, however, the limits on ownership compensation were only raised to 2.5 months total. Previously, in order to qualify for forgiveness, the rules required that 75% of loan funds go to payroll expenses. The Flexibility Act lowers this to 60%, allowing far more of the loan funds to go towards eligible interest, rent and utilities. Altogether, this should make it easier for business owners to spend these funds on expenses that allow maximum forgiveness.

The PPP does reduce the eligible forgiveness amount if employee wages are reduced below 25% or the number of full-time employees (FTEs) is reduced compared to a pre-pandemic measurement period. These two reductions remain, but the FTE reduction amount now has two safe harbors—one modified from the original law and one new one. The original safe harbor would allow businesses to ignore the staffing level reductions between February and April of this year if they hired back the employees by June 30; the new law extends that date to December 31, giving borrowers the rest of the year to get back to full strength. The new safe harbor allows the FTE reductions to be ignored if the business was not able to operate at full capacity due to guidance or requirements from the Centers for Disease Control and Prevention, Occupational Safety and Health Administration, or Department of Health and Human Services related to COVID-19. This safe harbor will likely apply to many businesses, so it will provide significant flexibility for applying for loan forgiveness.

And finally, the forgiveness applications have been overhauled. The original version was updated to reflect changes in the Flexibility Act, but a new “EZ” version also was released. The EZ version is 2.5 pages total, versus the original’s seven pages. Like most tax forms, it also comes with multi-page instruction sheets to aid in filling it out. The EZ form is available for self-employed borrowers or those who did not decrease employee wage levels or FTE levels (or qualify for the safe harbor exception). As we’ve discussed in the past, this forgiveness application also requires the borrower to supply supporting documentation. So, it is imperative that borrowers keep good records on how they use these loan funds.

Please join us on Monday, June 22, at 2 pm Central for a webinar where we will be discussing many of these changes and how they will affect you. AmSpa will endeavor to keep you updated on developments for this and other programs.

Tags:  Business and Financials  COVID-19 

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Member Spotlight: Where Everybody Knows Your Name

Posted By Administration, Thursday, June 18, 2020

avie medspa

By Michael Meyer, Content Writer/Editor, American Med Spa Association

Many medical spas tend to emphasize the “medical” half of the equation, and with good reason—the core of these businesses are medical procedures, after all. However, many successful practices understand that you can’t forget about the “spa” aspect. Making patients feel comfortable and safe is a key to a successful aesthetics practice, as exemplified by AVIE! Medspa and Laser Center in Leesburg, Virginia.

Southern Hospitality

Kim Marinetto, RN, created AVIE! Medspa in 2009. Prior to entering the aesthetics field, Marinetto spent 15 years working in a hospital setting; after having children, however, she decided to switch to a career that better reflected her commitment to health and fitness. Unfortunately, her initial exposure to the medical aesthetics business left a sour taste in her mouth—but it also inspired her to do something to improve it.

“When I was working for other practices, I found that they were doing it more for the money and not for patient care and results,” Marinetto explains. “So, I was motivated to open a business that was not available in my community; a place where people could come and safely be treated, keeping safety and efficacy first and foremost in our practice. We lead by making sure everything’s safe, and we do what’s right by our patient population.”

AVIE! offers a wide variety of treatments—from lasers to injectables to body sculpting—all overseen by medical director Khalique Zahir, MD. And although the practice’s experienced medical staff helps to ensure positive results from a clinical standpoint, Marinetto places a special emphasis on creating memorable experiences for her patients.

“When patients come in our door, they know that they are going to be welcomed with a big smile and probably a hug,” Marinetto says. “We know almost every patient by name and we greet them by name. They know that this is a safe haven. I compare it to Cheers—everybody knows your name when you come into AVIE! It’s a home—it feels comfortable, patients know that we love them and respect them, and we’re thankful for their loyalty to us.”

In fact, the COO of AVIE!, Roberta Kruse-Fordham, is a former patient who believed so much in Marinetto’s vision and ability that she agreed to join the team.

“AVIE! changes lives,” Kruse-Fordham says. “Kim gives confidence to people by improving their self-images, and also she’s just so compassionate and caring. She gives patients many options, and then lets them decide. We’re not about high-pressure sales. It’s very nurturing. I think the patients just feel that warmth and care.”

Marinetto and Kruse-Fordham have become a formidable team since Kruse-Fordham joined the AVIE! in 2017. Her focus on the practice’s systems and organization has helped to create an efficient business environment that allows Marinetto to pursue her passion for patient care.

“There’s a lot of planning that goes into everything, whether it’s our staff setup, our marketing or how we present retail,” Kruse-Fordham says. “There’s a lot of thoughtfulness that goes into the business, with regards to how Kim and I operate together with the team, how we operate with the clients, and how our team interacts with the clients.”

A Commitment to Excellence

Marinetto joined the American Med Spa Association (AmSpa) in 2015. Since then, AmSpa has kept her up-to-date with the laws concerning medical spas in Virginia, as well as best business practices that have helped AVIE! maximize its profitability.

“I actually became a member as soon as I found out about AmSpa, because I was super excited to know that there was an organization that was really looking into how medical spas should run,” Marinetto says. “I know there’s a lot of shady business out there, and I was excited to know that there was an organization that was going to help support everything I know needs to be taking place at a med spa, legally. So, I was like, ‘I really feel like this would be a worthwhile organization to be part of.’”

Marinetto and her team use the many resources available to them through their AmSpa membership to improve their business.

“Today, I was reading one of the articles on marketing and capturing leads, and I forwarded it to Roberta and my front desk team, and I reviewed it with my marketing team, because there are things that we can be doing better on the lead-capture side of our business,” Marinetto says. “I really do read through AmSpa’s informational emails—I learn a lot from it, and itreally helps me. When I’m not certain about something, I usually can find an answer [through AmSpa].”

Making a Difference

Marinetto’s desire to constantly improve her business reflects her devotion to her patients, which is truly what defines her practice. And although her definition of success is not strictly related to the bottom line like her previous employers, her passion for her patients guarantees that she feels fulfilled at the end of the day.

“Two weeks ago, I had a patient who was brand new to me. She had excessive sweating issues all her life and was in tears in my office,” Marinetto explains. “Our nurse practitioner said to do a hyperhidrosis treatment on her, and I did. She just came in yesterday for a two-week follow-up—we believe in follow-ups, follow-ups are important—and she could not stop smiling. And when I said, ‘How are you doing?’ she goes, ‘I’m great. I can’t believe it.’ Her smile was from ear to ear. And I said, ‘Has it been life-changing for you?’ She goes, ‘Oh my gosh, you have no idea.’ And that’s what really gets me excited. It inspires me to do more. It’s like the icing on the cake. It doesn’t get better than that. To have patients feel confident and be happy is really what gets me going.”

“And to add onto that, we had a patient who just walked out the door and said, ‘I could just spend all day here,’ Kruse-Fordham says. “We put her on a system last month where not only are we taking care of her skin as far as our membership goes—she has a membership, so she gets regular treatment and benefits—but she also went onto a program we implemented here with L-Nutra called ProLon. She just came in and she’s like, ‘I’ve already lost 11½ pounds in this program.’ Her skin is looking amazing. She’s like, ‘I absolutely just love coming here. I just feel so cared for.’”

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, contact us online or call us at 312-981-0993.

Tags:  Business and Financials  Med Spa Trends  QP 

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Skin Care Options to Support Treatment Outcomes and Boost ROI

Posted By Administration, Monday, June 15, 2020

retail products

By Candace Noonan, DermaConcepts

Why Is Skin Care So Important?

Pretreatment ensures that the skin is healthier, and therefore outcomes are better. Studies compare the effectiveness of treatments performed with and without skin care, and the results are extremely clear: Skin care is the key component to a better result.

Also, post-treatment skin care ensures a significantly reduced risk of pigmenting and/or scarring, as well as an improved healing time.

Controlling the treatment outcome ensures your success at being able to offer the most efficacious treatments, and this is backed and supported by a skin care brand that you can trust to complement that goal.

Ultimately, there is an opportunity to create client loyalty. Converting a new client is harder and more expensive then maintaining one. Using a trusted, results-oriented and scientifically backed skin care line is one of the strategic decisions that can keep someone coming back to your practice.

As we slowly emerge from completely restricted operations, the perceived value in retail—boosting practices’ bottom lines—has become an acute reality. Many practices’ source of income through this time has been retail products.

How to Choose an Effective Skin Care Line

  • Ingredients: Look for well-researched ingredients with a proven track record of results. Vitamins A, C and E, antioxidants, and peptides should be at the cornerstone. Look for skin-friendly “ester” variations that will ensure that the client can acclimate to high doses easily and without irritation.
  • Packaging: No product should ever be packaged in a wide-mouth jar. The exposure to air, light and heat degrade the actives, and a few weeks after using, you have nothing left but a cream that “feels” moisturizing on your skin.
  • Manufacturing: A dedicated manufacturing facility will be equipped to create superior products because the environment is completely controlled.
  • Step-up program: The ability to acclimate your skin slowly to progressively higher doses of multiple key ingredients not only creates healthier skin long-term without irritation, but also ties back into creating loyalty as clients are guided through the program. This is especially of benefit if the product has exclusive “medical-only” distribution and a “restricted online sales” policy.
  • In line with practice procedures offered: Whether your practice focuses on the face or body, products should be in line with your practice branding and offer support that speaks directly to those procedures.
  • Strategic partner: During these unprecedented times, it has become very important to align with strategic partners that are dedicated to your success. A vendor that can mold and shift policies to accommodate your specific needs during times of uncertainty forges lifelong relationships with an integral trust and ultimate understanding of your business needs.
  • Education: Advanced product and industry education will help you and your staff be confident educators for clients on the need to use your specified regimens for best results. Your skin care vendor should be able to offer you many different platforms and ways to receive education, not only on the brand, but also other factors of the business, and in a manner that not only keeps you and staff safe, but also engaged and excited.

Candace Noonan is a licensed aesthetician and master trainer for DermaConcepts, exclusive distributor of Environ Skin Care in the U.S., and hosts advanced trainings on this pharmaceutical grade line. She holds certificates for internationally recognized programs such as Advanced Skin Analysis, Dermal Needling and Oncology Esthetics, and is a proficient public speaker at medical and skin care conferences throughout the U.S. Her belief is to never stop learning, in hopes of sharing the knowledge gained by her continued studies. Born in South Africa, and having personal experience battling melasma, she feels her passion for skin care is her biggest asset.

Tags:  Business and Financials  Guest Post  Med Spa Retail 

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Leading in Times of Crisis: COVID-19 and the Health Care Industry

Posted By Administration, Friday, June 12, 2020


By Candela

In early 2020, it looked like it was going to be a relatively smooth year for health care. Sure, there were the usual rumblings in Washington about drug prices and reimbursement for medical practices, but health care didn’t seem like it was going to be at the forefront of the nation’s attention, as it often has been in recent years.

Then came the big bump in the road: COVID-19.

One day, there were patients in the waiting room, physicians, nurses and support staff scurrying from one room to the next and phones ringing. The next day, quiet. The next day, quieter. The next day, quietest. Appointments were cancelled, patients stopped coming into the office for anything but absolutely essential visits, and work started trickling away. Many of those with ownership stakes in their practices quickly transitioned into crisis mode.

“What should we do? How does our business survive this? Can our business survive this?” There is no playbook to follow when dealing with the COVID-19 crisis, no magic wand to wave in the air that makes problems go away. Most practice owners and operators are figuring things out as they go, adjusting and pivoting to the realities of every given moment. So then, what exactly can you be doing during this shutdown? How do you use this time to not only survive the present, but also plan to once again thrive in the future? Here are a few suggestions from practice owners and operators that may help you clear your mind, focus back in on what is important in your professional life and position your practice for success when your doors are once again allowed to open.

Review and Reflect

In normal times, so many practice owners and operators spend their days hustling from patient to patient, returning phone calls, overseeing marketing efforts and taking care of the hundreds of other pieces of daily minutiae. “There is no time for any of that other stuff,” is a common refrain.

Now, there is lots of time for that “other stuff.”

Strip down your practice piece by piece to figure out what is and isn’t working. Examine your financials, perhaps even going back five years. What is the return on investment on each core service you provide? Do you need to shift from performing fewer of certain procedures and offering more options that incorporate the new technology you have acquired for your practice? Talk to any staff you have retained during this pandemic to get their input. What marketing channels have been working best for you? Maybe that fancy new device you bought last year isn’t bringing in the revenue you expected. What are some possible reasons?

Do some research into your competitors. What do their websites look like? What sort of images are they trying to portray via social media? How can you differentiate yourself from their operations? Just as importantly, examine the practices of other operators you admire from around the country. Maybe you can arrange an exchange of ideas with a group of your peers in non-competing locales. This is a great time to step outside of your own practice and view your operation from the vantage point of the general public. Figure out the image you want to portray to your potential customers. Find your voice. This may also be a good time to reflect on the personal image you portray to your team. How is your employee retention? Does your staff seem happy? How can you keep them busy and productive while being sensitive to their personal situations? Are there small ways you can thank them for their dedication?

Something to think about: Over the years, you have probably ordered subscriptions to several things for your practice that automatically renew every month or year. Cancel all your professional debit and credit cards and ask your bank to distribute new ones with different numbers. Also, tell them that you do not want to roll over any subscriptions to the new cards. This will allow you to monitor every dollar going out the door so that you can evaluate its relevance to your operation.

Protecting Your Image

In the early days of the COVID-19 crisis, there was a rush across many industries to offer deals or special post-pandemic sales to customers in order to maintain some sort of regular cash flow. While understandable, this may not be the best time to aggressively push sales to your customer base. Some of them are likely struggling with their personal finances and might be turned off by aggressive solicitations from your practice. These promotions may also smack of desperation. “Why would I spent $1,000 to apply to a future elective treatment if it looks like this practice may not even be around when this pandemic is over?”

Instead of pushing sales, push education. Find ways to add value for your patients without selling directly to them. As your customers are cooped up at home, they likely are looking for ways to fill their days. This is a great time to offer a webinar on specific topics in which you have expertise that you feel would interest your patient community.

Something to think about: You may have some loyal clients who ask for a refund on that $5,000 gift card they bought just a few weeks ago during one of your specials, since they may now be struggling financially or have seen their stock portfolio tank. This is a tricky situation. There may be no legal obligation to refund the money, but it is an ethical decision. Is the short-term cash flow more important than the long-term customer relationship? Depending on your practice’s financial health, it may well be. Either way, it is a decision that can either damage or refresh your reputation with that patient.

Managing Your Finances

Government programs such as the Paycheck Protection Program (PPP) were designed to help small business weather the COVID-19 pandemic from a financial perspective, offering forgivable loans to allow employers to pay their staff during the crisis. Unfortunately, the demand for these loans far outstripped the current supply, and few small business applications were approved for funding during the initial round of funding. A second round of funding was approved in late April, with potentially more on the way. Still, practice owners and operators learned quickly that this program is not necessarily the financial panacea they were hoping for.

So what are some other options? For practices that applied for and did not receive PPP funds (or even, perhaps, for those that did), it may be worth talking to your bank about opening a line of credit for emergency use. Some banks may not be accepting these applications at the current time, but it won’t hurt to ask about them. If you are able to open a line of credit, use it cautiously, knowing that it is not a forgivable loan, but may help you in times of a real financial need, either now or in the future.

By now, practices have all made the tough decision on which employees to lay off, which to furlough and which to keep on the payroll. Perhaps you have even furloughed yourself to cut down on expenses. These are difficult decisions, and what makes sense for one practice owner may not for another. Perhaps hoarding your cash is the best approach for your practice. Perhaps spending on updates to your marketing materials or advertising campaigns to differentiate yourself when your doors re-open is wise. It’s really an individual calculation.

Telehealth is the one area of healthcare that has seen widespread growth during the COVID-19 crisis. Telemedicine visits are currently being reimbursed by the Centers for Medicare and Medicaid Services, as well as many private insurers, at the same rate as in-person visits. As the general public has grown more comfortable with video-based applications, the quality of these interactions is certainly improving. Will telehealth continue to play a significant role once the current pandemic is under control? It certainly seems likely.

Something to think about: What about some really outside the box options? Can you get your hands on COVID-19 test kits that you can sell to your patients? Be creative and think about things your patient population needs right now that you may be able to offer.

What Does the Current Crisis Mean for the Future of Independent Health Care Operations?

This is the big question on the minds of many practice owners and operators. Now that things are opening back up again in certain parts of the country, what is the landscape going to look like? It’s obvious by now that things are going to be different when individual states give the green light for elective surgical procedures. Even the boldest of patients may initially be apprehensive when they return to your practice. Your staff likely will be nervous as well. It’s important to develop a strategy now to figure out what your practice will look like when you do re-open. How many patients will you be comfortable scheduling in the first week or month? What is your cleaning routine going to look like between every patient? Who is going to need to come in close proximity to each patient? Will you provide masks and other protective equipment to each patient or rely on them to provide their own?

Then there is the financial health of your patient population. Are they going to be able to pay out-of-pocket costs for elective procedures if they or their spouse/partner has been laid off? How do you remain sensitive to the budgets of your customers while also focusing on your practice’s bottom line? What about the financial health of your staff? How badly will the loss of several paychecks affect them? How many may decide not to come back, either for financial or health reasons? How will you account for those contingencies?

Some practices may have traditionally relied heavily on educational events where they invited prospective patients to learn more about the services they offer. These will likely need to look quite different, at least in the short term. However, patients will still need education of some sort, so will you be a pioneer in figuring out the best way to reach potential new customers effectively?

Don’t forget to lean on your most trusted vendors. They are likely coming up with their own materials to help their customers survive the COVID-19 pandemic. Everyone wants some sort of “grand re-opening” event, though it is likely going to be much more muted than anyone would want. That said, you are going to need to let your patients know when you are planning to re-open for routine visits and what that is going to look like. Once you set a firm date, let some of your vendors know as well. Perhaps they can help spread the word or offer promotional materials for you to adapt for your customer base.

This is, of course, not the first time that society has been faced with a regional or global crisis. Millions of people, including health care owners and operators, are now being faced with the same sort of challenge. You can either hole up, cross your fingers and hope that things will magically get better, or you can be a proactive driver of change to shore up the short- and long-term health of your practice. What kind of leader will you choose to be?

Candela is a market leader in the medical and aesthetic laser and light-based technology market. The company’s products are sold in 90 countries worldwide and are backed by field service, clinical education and marketing support organizations. Candela offers customers a broad product portfolio, enabling physicians to provide advanced solutions for a wide range of medical aesthetic applications, including body contouring, hair removal, tattoo removal, wrinkle reduction, and the treatment of vascular and pigmented lesions, acne, leg veins and cellulite.

Tags:  COVID-19  Guest Post  Med Spa Trends 

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