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UPDATED—The Hyaluron Injection Pen: Is It Legal? Who Can Use It?

Posted By Administration, Monday, August 26, 2019
Updated: Monday, August 26, 2019

medicine

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

ORIGINAL STORY [7/1/2019]: The Hyaluron Pen is a new injection device that is gaining a lot of buzz overseas. It claims to deliver injections of fillers—typically hyaluronic acid—in a less invasive and painful way than typical needles and syringes. As these products make their way to the U.S., it must be noted that currently, no device is U.S. Food and Drug Administration (FDA)-approved for injecting hyaluronic acid and other fillers in this way. We have seen several ads and notices that offer to sell these devices and provide training for them. Before you make a purchase, you may want to know: Is it legal? And can you legally perform this procedure?

When a medical device gains FDA approval, it can legally be marketed for that specific approved use. We have discussed issues with using approved devices in unapproved ways—so-called “off-label use.” In this case, we were unable to locate an FDA marketing application for a hyaluronic acid injector. According to an FDA guidance document on needle-free injectors, this type of device would likely by regulated by FDA’s Center for Biologics Evaluation and Research or Center for Drug Evaluation and Research as a “combination product.” General-use needle-less or jet injectors are regulated as Class II medical devices. In general, without an FDA marketing or premarket approval, a product manufacturer cannot legally sell or advertise a device for unapproved use; this marketing prohibition extends to purchasers of the product as well.

Since this product is so new, there are no specific laws that directly address who may use it. Instead we must look at how similar procedures and technologies are treated. Unlike a traditional filler injection that uses a hypodermic needle and syringe, this device uses a high-pressure jet to inject the fillers through the skin without the use of a needle. This makes the device similar to other needle-less and jet injection systems that sometimes are used to deliver vaccines and other medications.

While the injection technology is novel, the treatment is fundamentally the same as traditional filler injections. Although there is no needle being used, the skin is still being “pierced” by the jet of hyaluronic acid. As such, we believe these pens will follow the same or similar rules as injecting filler using traditional syringes. Therefore, the use of these devices is a medical treatment, so a good-faith exam must be performed before the procedure, and if the physician is not administering the treatment him- or herself, it must be properly delegated. Unfortunately for practices that would like to use unlicensed practitioners to use pen injectors for fillers, this takes the procedure out of the scopes of practice for aestheticians and most LVNs.

To learn about legal and business best practices to keep your med spa compliant and profitable, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps and become the next med spa success story.

UPDATE [8/26/2019]: AmSpa has become aware that the Texas Medical Board (TMB) has issued at least one and possibly more compliance letters regarding Hyaluron Pens. We don’t have all of the details on this issue, but it appears to have stemmed from health inspectors noticing a Hyaluron Pen at an aesthetician’s station during a salon inspection.

In the article below, we noted that even though these pens do not use needles, their use is considered the practice of medicine, and these procedures need to be performed by appropriate persons under medical supervision. This TMB letter, at least for Texas, confirms that belief, and we see no reason other states would take a different view.

It is our understanding that Hyaluron Pens are being promoted through seminars and trainings; these trainings seem to be marketed primarily to aestheticians and cosmetologists. Remember, before you spend any money or time on any training, it is important to verify that you will be legally able to perform the procedure. (See here for more information.)

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with David Prokupek of Ideal Image MedSpa

Posted By Administration, Friday, August 23, 2019

david prokupek

Prior to the economic downturn of 2008, medical aesthetic franchises were common; however, ever since the Great Recession, the industry has been dominated by independent practices. Today, large chains are beginning to re-emerge, led by Ideal Image MedSpa, a Tampa, Florida-based company that boasts 137 locations in the United States and Canada. AmSpa Content Writer/Editor Michael Meyer recently spoke with Ideal Image CEO David Prokupek about the company’s ability to offer patients convenience and high-quality care.

Michael Meyer: How did you first get into the medical aesthetic business?

David Prokupek: I got into medical aesthetics in a couple of ways. My brother is a doctor out in Los Angeles, and he's a little bit in this business; I was helping him look at the category. And then I got a call from the L Catterton guys, our private equity firm, who I'd known for the last 15 years, and they told me about this great opportunity and investment that they had in Ideal Image. Over about a 60- to 90-day period, I looked at the business and finished out all the industry work, and here I am.

MM: What would you say is the most important factor to your success as a company?

DP: There are a number of factors to our success, but one of the main ones is that the leadership position that we hold in the industry gives us a tremendous amount of resources to really provide every client with a team of medical experts, and skin, face and body specialists. It's a unique position in the industry. A lot of people are very curious about how this noninvasive world works, so we're able to give them a counselor to help guide them through that and a medical professional, nurses and the like to do the treatments. That's been a big part of our secret sauce. Our consumers and clients really like the fact that we are a one-stop shop for everything—skin, face and body. We’re doing a tremendous amount of injectables, laser hair removal and body-sculpting. And we’re surprisingly affordable. Our average client is an average American, and we’ve figured out through our scale how to make the services surprisingly affordable. That’s added up to a lot of success for us.

MM: What makes your med spa different from others?

DP: I do think that our medically driven model is different. We are very much on trend about what's working and evaluating a lot of new services that are in the marketplace. And convenience has become an increasingly important part of our success. This last year, we've gone to same-day treatments for Botox and injectables, and almost half our business is happening that way right now. We're open late in the evening. And we've just put in all these 3-D skin Reveal cameras to really start to provide personalized analysis, especially around the face and skin. I think people really appreciate that personalized approach to the business.

MM: What is your most popular treatment? Which one brings in the most revenue?

DP: It's been changing. This past year, from a popularity perspective, Botox, facial fillers and injectables have become among the most popular things that we do. That business has been more than doubling this last year, and is really fueled by a broad interest from young women in their twenties to folks my vintage. There is a high, high level of interest amongst Americans as to what role injectables can play.

In terms of total revenue, our laser hair business still brings in the most money every year, but it's getting very balanced across body-contouring, injectables and laser hair at this point.

MM: What specific metrics do you use to determine success?

DP: As a leader of business of our size, I look at a balanced scorecard in terms of measuring our business. We spend a lot of time on consumer metrics, around net promoter score, satisfaction and ratings, as well as people's likelihood to recommend us. I look a lot at what our traffic looks like, from new clients to existing clients coming in and their purchase patterns with us. I think it's important for us to build a balanced approach to the business, so I’m really focused on the growth in the various modalities, including laser, hair, injectables, skin resurfacing and the like. The last thing is around our people, in terms of tenure and productivity and those kinds of metrics.

MM: What do you love most about aesthetics?

DP: I love that we really can help people look and feel their best naturally. People just feel good after they leave one of their clinics, and it's just a really uplifting industry to be in.

MM: What do you love most about being an entrepreneur?

DP: It really lets you create a platform to be transformational, to take risks and to try new things without a lot of constraints. That's really played to my skillset. I think, personally and professionally, it's very rewarding to be able to try those new things and be very creative. My style of being an entrepreneur has been to partner with private equity firms—in this case, L Catterton, the leading consumer private equity group. It helps me get the best consumer thinking and capital to be able to grow, and it's really energizing.

MM: What advice would you give to other med spa owners?

DP: I think it's really important, as an industry, that we really are transparent to what the client wants and needs regarding how our services work, and that we listen. I think it's really important that we focus on delivering results that are natural. And I think, personally, that focusing on the consumer, around convenience and service hours and services, is really something that's going to be important as the med spa category takes market share from other traditional places. I think if we focus broadly as an industry on those things, we're going to all do very well.

ideal image

MM: What is the goal with the clinic design that you incorporate into your facilities?

DP: We're continually working on our design, but I think one of the most important aspects of our design is to be warm and to be welcoming. I think that's critical. But patients should also have a sense of privacy. More and more people are talking about the procedures they're having, but there's also still an innate sense of privacy, confidence and intimacy that people want to have. The design, both in the consultation rooms and the treatment rooms, needs to be set up well for that. I would also say location—we’re trying to be more ‘Main on Main’ and in the flow of where our consumers live and work every day, versus being hidden away, and build the brand through visibility and convenience.

MM: What do you think is the benefit of your many locations? How does that affect your business?

DP: We have the benefit of having about 140 locations in a lot of states and in Canada. I think there are a couple of things that gets us. In terms of purchasing scale, we're almost everyone's biggest customer in the aesthetics business. It affords us a level of scale that we get to pass onto the consumer. One of the reasons I stepped into this role is that I really believe that building and having a brand that people see in the neighborhood around the United States inspires confidence. I think that gives us a lot of benefit to customers who start their treatments at one clinic and ultimately transfer to others along the way. I believe that as the leader with the locations, we have the ability to help set the standard for what a great business model from a consumer perspective and business model can look like, and that scale is going to bear fruit for us.

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Business and Financials  Med Spa Trends  QP 

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How Practices Can Effectively Use Social Media

Posted By Administration, Thursday, August 22, 2019

filming surgery

By Renee E. Coover, JD, ByrdAdatto

Social media in plastic surgery practice continues to explode, driven by the marketing opportunities created by the public’s unabashed desire for before-and-after photos and live patient surgeries. But with this reliance on social media to market and advertise, a plastic surgeon’s practice assumes often unknown risks. In a recent Los Angeles Magazine article, Beverly Hills Plastic Surgeon Ashkam Ghavami, MD, who has almost 400,000 Instagram followers to his practice, acknowledged the challenges in balancing ethics with entertainment. According to Ghavami, “Because social media is the most valuable marketing tool of our trade, some surgeons post deceptive before-and-after photos of patients on social media. This creates an uneven playing field and, worse, harms the potential patients who are trying to choose their surgeon.”

Questions arise as to what is appropriate or legal for a physician to advertise on social media: Does it require patient consent? Who ultimately owns the content that is posted to social media?

Here are some key compliance considerations for social media in your plastic surgery practice:

  1. Obtaining patient consent. Patient consent for social media use should be separate from other consents. Consent must deal with the circumstances of the social media use. A wide range of circumstances that can impact consent. Before you ever post before-and-after photos of a patient’s Brazilian butt lift, you must obtain written consent from your patient. Likewise, if your patient brings in a friend or relative to live-stream a video of his or her medical procedure, it still requires direct consent from the patient. Without patient consent, a plastic surgeon puts his or her license at risk by posting patient photos or videos to social media.
  2. Physician advertising rules. Physicians are subject to specific state medical board advertising rules that control the messages they advertise so as not to be deceptive or misleading to the public. The Federal Trade Commission (FTC) also regulates physician advertising. (For more on this, read Michael Byrd’s recent article “FTC Focuses on Social Media for Truth in Advertising.”) The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) also regulate physician advertising; for example, check out this article, which discusses the first code of ethical behavior for sharing videos of plastic surgery on social media, published by Northwestern plastic surgeon Clark Schierle, MD, and presented at the ASPS annual meeting. Using “enhanced” before-and-after photos or stock image photos, using models, allowing staff to post their personal beliefs and opinions on your social media accounts, and communicating directly with patients via social media are just a few ways plastic surgeons get in deep trouble with physician advertising laws.
  3. Ownership of social media. The ownership of content posted by employees often is unaddressed. For example, physicians and nurses often post before-and-after photos to their personal social media accounts. This creates both potential infringement issues and patient privacy issues. As attorney Bradford Adatto noted in his recent article, “5 Key Details Every Plastic Surgeon Should Know About Their Employment Agreement,” relating to plastic surgeon’s employment agreements, there are a substantial number of patient privacy laws to understand before posting patient photos to social media. Further, if the practice intends to keep all social media content as its property, whether it is posted to a practice account or an employee’s personal account, this needs to be addressed in a social media policy.
  4. Social media policy. A variety of issues arise when using social media to advertise medical services; thus, it is crucial for every plastic surgery practice to develop a social media policy to address issues such as employees’ use of social media and ownership of the content. The social media policy also should be mentioned in your employee handbook. Simply having a social media policy is not effective unless all staff have been informed of the policy and management is trained to implement and enforce the policy.

All this information also applies to medical spas. To learn more about how to effectively use social media in a medical aesthetic setting, consider attending an AmSpa Medical Spa & Aesthetic Boot Camp. Each Boot Camp features a session on social media, as well as useful information about all aspects of running an effective medical aesthetic practice. AmSpa Members save when registering for Boot Camps—click here to learn how to join.

Tags:  ByrdAdatto  Med Spa Law  Med Spa Trends 

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Understanding Microneedling Equipment

Posted By Administration, Tuesday, August 20, 2019

microneedling

By Justin Harper, MD, on behalf of Bellus Medical

I often say that microneedling is the single most underestimated treatment in the current anti-aging rejuvenation, and beauty industry space. I think that, whether you're a medical spa, dermatology office or plastic surgery practice, it's a key component to help patients maintain a natural look and correct anti-aging lines, wrinkles, hyperpigmentation and, in many cases, inflammatory conditions. It often makes a tremendous impact on acne scarring, and I think the fact that there are no thermal injuries associated with it, unlike many of the other treatments out there, makes it truly safe for all skin types. The industry has never had something like that, and if it did, it was probably under-recognized or underappreciated.

The opportunities for microneedling are expansive, but providers have to be extremely cautious. Much like the tattoo industry for some time didn't realize the true impact or the potential risk of exposure to blood-borne contaminants, one would think it's something that in we in the medical space automatically understand and work toward correcting, but many of the devices on the market are poorly produced, and don't have any type of protocol or the ability to truly keep blood-borne contaminants out. If you were to compare the quality of most of the microneedling devices in the market to even run-of-the-mill tattoo guns, you would find that even tattoo parlors can often maintain sterility at a level that's higher than medical offices, given some of the gaps or deficiencies in the way the equipment is built.

When I think about the SkinPen device, for example, as much as I like the consistency, I don’t always love the higher costs of the tips. At the same time, I understand that it protects and creates a clear barrier between the patient and the device. One of the fundamental things that we could do wrong is to expose people to blood-borne illnesses. This would force us to take a step back in our progress of enhancing the overall beauty industry, and create fear or an additional aversion to microneedling, which is probably something more people need to participate in but haven't had the opportunity to learn about. It’s important to me to choose a device that not only works well and is consistent, but also, more importantly, is FDA-cleared and has the same attention to safety precautions that I do with my patients. I don't have the luxury or the opportunity to allow any lapses in judgment or equipment quality to compromise patient safety. I choose to go with devices that take out any guesswork and give me peace of mind.

We look forward to more people learning about and participating in microneedling. Specifically, we've done a lot to enhance the overall process and delivery of these types of treatments. Unfortunately, “microneedling” still is a name that gets used wrong probably 99 times out of 100 times, compared to what I would actually define as true microneedling. Much of the what is called microneedling isn't going to achieve either the quality of the results or the consistency of results that we're able to achieve. We do this by customizing our protocol, using a good device and making sure that the treatment is performed consistently. That truly lends itself to reproducible great results. I think it's important that you not only have clean facilities and a good device, but also have somebody who knows how to optimize for quality results.

It's not uncommon to have somebody come in and, when I recommend microneedling as part of their treatment regimen, they say, “It's okay—I've already done that, and I'm not interested in doing it again.” I ask them to describe the process and describe what was done. When they give me a recollection of how much redness they had, how it was performed and what kind of device was used, I usually tell them the treatment they received is not what we would define as microneedling. Going through the procedure once or twice is the only way for me to prove that. You'll be able to see the difference, and you'll change your mind very quickly about how important this is for your overall anti-aging and beauty regimen—not just today, but moving into the future and as a maintenance item that you're going to want to continue with for the rest of your life.

At Juvly Aesthetics, we have the protocol to give people quality results across the board, and that's really what we value. We value giving people transparent pricing consistently, and top-of-the-line results in a way that's convenient and comfortable for patients, and I believe that starts with the providers with whom we choose to partner.

Justin Harper, MD, is medical director for Juvly Aesthetics.

Tags:  Guest Post  Med Spa Trends  Microneedling 

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QP Extra: Q&A with Marria Pooya of Greenwich Medical Spa

Posted By Administration, Friday, August 16, 2019

marria pooya

After having her second child, Marria Pooya contemplated becoming a full-time mom, but the former Wall Street financial analyst couldn’t resist the call of entrepreneurship and set out in search of new opportunities. In 2005, she founded Greenwich Medical Spa in Riverside, Connecticut; today, the practice has three locations and is thriving, thanks in large part to Pooya’s drive to succeed. Pooya recently spoke with AmSpa Content Writer/Editor Michael Meyer about her journey through the world of medical aesthetics.

Michael Meyer: What inspired you to open your practice?

Marria Pooya: My background is Wall Street. I was a financial analyst covering the high-yield sector companies like consumer products and retail chains. I did that for about three years, and then I worked for a consumer products company where I helped develop two color cosmetic lines that were sold in mass retail stores like CVS and Rite Aid. When we had our second child, I actually wanted to be a stay-at-home mom. It didn't really last long.

Six months later, I got the itch to open another business. I actually wanted to open a candy store—something like Dylan's—and my husband said, “Why don't you just go online and see if there are any franchises out there?” And when I did, that's when I learned about the med spa business, because there are a couple of franchises out there, and I knew that that's what I wanted to do. I love the beauty business, so I felt like that was my calling.

The next thing we know, we're on a plane to Arizona to buy a med spa franchise. They had the sexy story—baby boomers getting older, they have disposable income, they want to look younger and they don't want to have surgery. So, $80,000 later, we come back and we have a franchise, but we found that that the franchise was actually a sham. They had the sexy story but not the experience to carry out the vision. So we sued the franchisor, got out of our franchise agreement and then changed our name to Greenwich Medical Spa.

MM: What's different about your practice now versus when you opened?

MP: Well, when we first opened we were only four people, and now we're, like, 25. That's the main difference. But also, when we first opened, it was very different. You didn't have a lot of the non-surgical technologies that we have today, in terms of what we could provide to our patients at that time. You had Botox, fillers, laser hair removal and an IPL machine, and that's it. That was the technology 14 years ago.

Now there are so many different modalities for non-surgical treatments, from skin tightening to non-surgical fat reduction, like CoolSculpting, to now threads for lifting the skin. This industry has really dramatically increased, maybe twofold or now threefold, so there are more options for the patients. That's the main difference.

Also, people are more accepting of injectables, like Botox. Fourteen years ago, nobody talked about Botox, and when somebody had it done, they didn't tell their friends. Nowadays, it's a lot more common and acceptable.

MM: What's one word you would use to describe your med spa journey?

MP: Probably “growth.” Coming from Wall Street, I didn't have the experience to manage a staff. I think that for myself, a lot of growth has happened in the past 14 years. I've become a better manager. When I was working on Wall Street, the philosophy was that you pay people well and you expect them to do the job, and that's it. That's all it was. It wasn't about encouraging the staff members, saying a “thank you” or “please,” or helping them develop. Over time, I’ve become a better listener, a better manager, and I've learned a lot.

MM: What is your most popular treatment?

MP: Hands down the injectables. Botox is a big part of our business. People come in for that, and then we're able to up-sell them to other treatments. It's a treatment that is well-known in the population, because it's advertised a lot and people are talking about it. It's a great treatment. Botox is about 22% of our business, and injectables are 39%.

MM: What's the most important factor in your success?

MP: I think that the most important thing is your employees. It's really important that we have the best customer service for our patients, and that starts with our employees. It starts from the front staff to the mid-levels who actually are providing the treatments to the back office, who are helping support both the front and the back. The staff can make you or break you. It's how they treat the clients and if they believe in your vision. It's the welcoming tone that they have on the phone. It's the person who's doing the treatment and who actually cares about the patient and listens to them—truly listens to them—and tries to become a partner with them in their journey of rejuvenation. Employees are really, really important, and it's been a huge learning experience for me since opening the business.

In the beginning when I had opened the business, we were going through a lot of turnover where I didn't know how to manage my staff. I wasn't a good manager—I wasn't a good leader. We were just hiring people to fill in positions. Now we're actually going through a process—we're hiring the right fit, people who actually believe in our vision, believe in what they do and love what they do. The fit is really important with us. One of the reasons why we've been successful is we have a team that works really, really well together. They love coming to the business. They look at it as if it's their own business. They feel invested in it, and that translates into happy clients who leave here, leave great reviews and love coming back.

MM: What would you say makes your med spa different than others?

MP: I think that it starts with the customer experience. Let me just take you through the journey. Say that we get a lead that comes in an email. The first thing we do is call the patient up immediately and try to get them to come in for an appointment. Before they even come into an appointment, we send them a video describing what they should expect during their consultation. When they come in, the person gets up, already knows the patient's name, greets them, brings them in and then hands them off to the clinician who does the treatment. When the patient leaves, we send them a handwritten thank-you letter as well as their treatment protocol, and then we call them back after the consultation to see if they have any questions; we also do that for follow-up visits. After every treatment that we do, somebody calls the patient and asks if they had a great experience and if they had any questions. I don't believe anybody else does that. It's that kind of experience that we give to our patients that sets us apart from everybody else.

Besides that, though, we have an amazing reputation in the community because we've worked really, really hard to get some of these accolades. For example, we are the number-one provider of Botox and CoolSculpting in Connecticut, and also in Westchester County, New York, and we're top-100 out of 20,000 locations, and that's because of the volume of these treatments that we offer. We have a reputation in the market that we give great customer service, we give great outcomes for our patients, they're happy with their results and they're willing to come back.

greenwich medical spa

MM: Who inspires you?

MP: My husband. He works behind the scenes and is a huge support system for me. He's always given me great advice. He tells me to calm down when I'm anxious and nervous. He's been a really great motivator. I guess that's another reason that I'm successful. Also, I feel that your employees can make you or break you, so having great employees who are happy also tells me that I'm successful.

MM: What do you love most about aesthetics?

MP: I love the confidence that it gives people. Just a little bit of enhancement—a little bit of Botox in the forehead lines and removing those lines—can make somebody feel so much better about themselves. Just coming in here and talking to somebody, and they tell you, “You know what? You don't need anything,” they leave feeling better. That's great. That's what I love. It's the confidence that this business gives to people. I love that. I love making people feel good about who they are every single day.

MM: What do you love about being an entrepreneur?

MP: I love the challenge. My father is an entrepreneur and it's in my blood. I love the fact that it's something that is hard to do. The statistic is, I think, 90% of the businesses fail within three years, so we would sit there and say, “Okay, we need to make the three-year mark.” And then once we hit three years, then it was like, if you make it to five years, you have an 80% chance of surviving and doing well. When we hit the five year mark, we're like, “Okay, we're safe.” And then 10 years was like, “Okay, now you've made it.” What I love about being an entrepreneur is that challenge of every day waking up and trying to find out, can we make this business successful? Can we drive this? Can we get this to the next level? That's what I love about it.

Also, when you're an entrepreneur and you're a decision-maker, you can make changes really, really quickly versus a corporate business. If you, for example, come up with a marketing idea, you could implement that within a day, whereas when you are working for a corporation, it takes months to do that same thing. For example, if you want to introduce a new technology or a new service, when you're an entrepreneur or a startup, you can just go in and take the dive—do your research and do that. However, if you are a chain or if you are in a corporate world, you have to go through these processes and systems to make sure that this is what you need to do. That's why I love it—you can implement something really quickly or take something out of your business really quickly versus being working for a corporation. I love that.

MM: What advice would you give to other med spa owners?

MP: I think that customer service is really important. What will set you apart from your competition? Will it be the customer experience? And that starts with your employees. So, it's really important that you make sure that you have the right fit and invest in your employees—pay for education and training, pay them above-market, and make them feel that they're really part of the business.

Also, when you're starting out, it's really important that you focus on your margins and keep your overhead low. Maybe start out hiring part-time positions. For example, when I started my business, besides my spa coordinator, everybody was part-time—my aestheticians and my mid-levels. This way, I save on paying benefits such as medical insurance, 401k and PTO. Also, when you're scheduling your treatments when you're starting out, work three to four days out of the week instead of five to six days. When I started out, we were open Tuesdays, Thursdays and Saturdays, and then we added Friday and Wednesday as we got busier. When people asked on a day that we didn't have staff, we just said that we're fully booked. Really think about the bottom line and try to focus on your financials, because this industry is such a high overhead business.

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Business and Financials  Med Spa Trends  QP 

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How to Stand Out in the World of Medical Aesthetic Offices

Posted By Administration, Wednesday, August 14, 2019

medical spa treatment

By Terri Ross, Terri Ross Consulting

When I first started my business, I was well aware of the positive impact I would make; however, the outcomes have far exceeded my expectations. Providing growth strategies is my passion, and I want you to dive into reading some of the ways I’ve helped businesses get to where they are today. This is for business owners who want to make their businesses stand out and shine, and want to stay ahead of the industry.

In this post, I will take you through some of the criteria that every practice needs to consider when entering the aesthetic market, and continue to monitor and evaluate for continuous success.

In the world of medical aesthetic offices, competition is fierce—and steadily increasing. In order to succeed and stand out against the sea of competitors, your office must exceed expectations. This means every aspect of your office—from the infrastructure, processes, systems and staff to location and marketing strategies—must be carefully planned out and executed. Knowing where you are by the numbers is one critical part of managing growth and optimizing your processes. Read more about key numbers you should know here.

A knowledgeable and engaging front office staff, informed marketing strategies, state-of-the-art technology, trained clinical providers who are able to perform a successful patient consultation, and, more importantly, systems and processes are all integral parts of a top performing medical office. In my eight years of experience transforming new or average-performing medical aesthetic offices into top-performing practices, I’ve developed a list of six key components that differentiate highly successful medical spas or practices.

Well-Trained Front-Office Staff

Your front-office staff is the face of your office. It is critical that all members of the front office are well trained, knowledgeable, informed and engaging.

The job of the front-office staff is two-fold:

  • To engage, listen and inform prospective patients of the high-quality care your office offers; and
  • To continue to offer the highest quality of service to current patients, which relates directly to your patient retention.

When a prospective patient calls your office, the front office staff must quickly and effectively convey the message that your office offers the highest-quality care, technology and expertise in the market. Therefore, it is critical that all members of your staff are knowledgeable—that they know the details of every procedure and treatment you offer. Further, it is imperative that they know how the treatments and services offered in your office compare to those of competitors and are able to relay that information clearly and concisely to potential patients. By listening, engaging and responding, your front-office staff will consistently convert prospective patients into long-term patients and ensure current patients are satisfied and return. Click here to read more about the LAER model I developed for effectively training your front-office staff.

Passion

To start and maintain a top-performing office, you will undoubtedly need passion for patient care and business. Aside from developing the initial expertise required to start your office, you will need to stay informed about and ahead of new technologies, and successfully incorporate these into your practice on a regular basis. This takes passion and drive. Also, you’ll need passion for business. Know your office by the numbers: potential ROI on equipment and marketing strategies, new patient rates and room revenue assumptions, to name a few. Read more about critical numbers you should know here.

Plan for the future. Consistently and creatively think of new ways to expand your business and implement the necessary changes for future growth. New marketing strategies, processes and protocols, as well as staff training are included in a comprehensive plan for office growth and optimization. To lead both the medical and business sides of your office, you certainly will need passion and a keen sense of determination.

Marketing Strategies

Marketing strategies are critical in the world of medical aesthetic offices. You need to stand out among the sea of competitors, and the most direct way to do this is to be known. Make sure potential patients know you exist. And, further, make sure they know key elements that make your office unique: state-of-the-art equipment, the highest quality of service, personalized treatment plans, etc. In other words, brand your office.

Making specific goals and implementing strategies to get there are other important aspects of effective marketing. If your goal is to increase new patient leads by 50%, implement fresh and innovative advertising and/or offer new promotions to attract potential patients. Measure your progress and keep track of your marketing ROI. Read more about how to build a successful marketing plan in this article from the Huffington Post.

Location

Choosing the right location for your medical aesthetic office is key. The right location takes a number of factors into consideration:

  • Where your prospective patients live, accessibility and convenience;
  • If your office is centrally located and convenient to a broad base of customers;
  • Your office’s visibility; and
  • Your office, the physical structure, the sign and the parking lot are central parts of your marketing strategy.

A well-located office attracts new patients and helps to ensure current patients return.

State-of-the-Art Technology

Treatment and procedure options in the world of medical aesthetic offices are constantly evolving, as new research emerges and new products become available. To offer the best possible service to your patients, you will need the best tools. This means that in addition to staying on top of emerging research trends, you will need to assess, budget for and acquire new equipment for your office.

This requires careful research and calculations:

  • Initial cost, maintenance costs, training and treatment pricing all go into calculating the potential ROI for a new piece of equipment; and
  • Consider your competitors when choosing which equipment to acquire. Do you offer new and/or different technology compared to your top competitors? How will you differentiate your office?

New technology goes hand inhand with staying on trend with the newest medical aesthetic treatments. You want to make sure you have the proper tools to offer the best service.

Staying On Trend

It is imperative that you stay ahead of new technologies and treatment options. This requires knowing the research and implementing changes ahead of time to acquire new equipment and the expertise to use it. This also requires that your office staff and clinical medical providers are continually learning the technology and portraying this information clearly to prospective patients. In this industry, prospective patients often know what they want, and they are seeking out the right office to offer that service. Make sure your staff is informed and knowledgeable of the technology you offer. State-of-the-art technology, a well trained staff and creative marketing strategies will ensure that you consistently land and retain patients seeking the newest available procedures.

In conclusion, comprehensive and consistent setup of your practice requires constant fine-tuning, and it is helpful to engage the help of a professional who can look at your practice with fresh eyes. As a busy doctor or business owner, your focus is on treating your patients, but the same care is required to build the business.

Click here to learn more about training with Terri Ross.

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  Guest Post  Med Spa Trends 

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How to Choose the Right Aesthetic Partner

Posted By Administration, Monday, August 12, 2019

handshake

By Cynosure

Are you ready to get into aesthetics, but are struggling to choose the right company? Ensure that you’re partnering with a company that is truly invested in your success by asking yourself:

  • Are they driving quality client leads to your practice and helping you convert leads to consultations? A vendor should make it a point to help you drive leads by having your business appear at the top of search results across the web and on social channels while also making it easy for patients to book appointments.
  • Do they offer services that provide 24/7 access to branded marketing materials for your practice? Look for vendors that provide quality marketing materials that remain fresh and help you successfully market treatments to patients.
  • Will you have marketing specialists dedicated to helping your practice thrive? Will they offer guidance on handling client objections? A vendor should make it a priority to provide marketing guidance and support, as well as assist with handling client objections. Look for vendors that have marketing specialists specific to your business who are available to assist you whenever you need it.

Cynosure offers quality technology with a comprehensive product portfolio and practice support team to ensure user success. It is partnering with AmSpa to provide exclusive access to discounts on capital equipment that drives revenue and results to users’ business.

Tags:  Business and Financials  Guest Post  Med Spa Trends 

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QP Extra: Q&A with Shawna Chrisman of Destination Aesthetics

Posted By Administration, Friday, August 9, 2019

destination aesthetics

When Shawna Chrisman, acute care nurse practitioner, opened Destination Aesthetics in 2011, she hoped it would provide her with some flexibility and positivity, both of which were in short supply in her previous career in critical care medicine. Thankfully, medical aesthetics became her passion, and she recently spoke about her career and love of the industry with AmSpa Content Writer/Editor Michael Meyer.

Michael Meyer: What inspired you to open your practice?

Shawna Chrisman: I was working as a nurse practitioner in an acute care setting in critical care medicine in the hospital, and I was looking for something to do on the side. I was looking for something with a little bit more flexibility because of my kids and my family. I thought it would be something fun and positive instead of something sad—I was working in a hospital setting and taking care of dying patients. That is actually what inspired me. It really wasn't to build Destination Aesthetics into what it is now. That was never part of the business plan at all. It was really just something to do on the side—something fun and uplifting and something that I thought would bring some positivity with my licensure and professional degree.

MM: What's different about your practice now versus when you opened it?

SC: I started it just with myself as a solo provider and my medical director as my partner. I mean, I was the receptionist, I did chemical peels, I did my bookings, I was the janitor, I did my ordering—I did everything in one room, and now we have three locations and 27 employees, and we’re ranked number four in the nation with Allergan a little over seven years later.

MM: What's your most popular treatment?

SC: We focus on cosmetic injectables, so Botox, primarily, and fillers.

MM: What do you think is the most important factor to your success?

SC: Passion is the most important factor, because I'm not in it to make money. I'm not in it for the attention. I'm in it because I love it. I love what I do. I love my patients, I love my team, and it's just a positive feedback loop that keeps giving. That's what's empowered us to move forward and be successful in a short amount of time. It's all because of the passion for our industry and for our patients.

MM: What makes your med spa different from others?

SC: What sets us apart is, I would say, our level of patient satisfaction, and again, our passion and our pride in what we do. Really, it's our teamwork. We have a very strong, cohesive team. We hire from the inside out, with strong minds and powerful hearts who really care about the patient and about each other. I'd say that that is the primary integrity—the core of Destination Aesthetics. There's so many things that really set us apart, but primarily I'd say it’s the integrity and passion that we have for our patients. I mean, I think everyone would say that, but again, it's that positive feedback loop that we keep revving us up and empowering us to continue to do the best that we can do.

MM: What specific metrics do you use to determine success?

SC: We look at all of the benchmarks that, I'd say, everyone kind of pays attention to—the profit and loss, profitability and net income. We look at patient satisfaction rates, we look at patient retention, we look at first-time patient retention. We pay attention to the percentage of retail to overall revenue. We look at run rates on inventory. We look at return on investment from marketing. Those are kind of the metrics that we focus on.

MM: Who inspires you?

SC: I get a lot of my inspiration from my patients, because I see a lot of survivors of horrible tragedy. I see patients who survive terrible medical diagnoses. A lot of my patients' stories have inspired me, and there are a few that really come into play. One is a patient who was beaten in her own front yard when she was playing when she was seven years old. This guy got out of his car and just started beating her with a baseball bat, and it was a hate crime because of her race. Because of that, she had multiple facial fractures and had to literally have her face rebuilt. The power that we have with what we can do with our hands, making someone feel confident and beautiful, is really the driving factor and what keeps us moving forward and kind of paying it forward, but in a different way that no one else would understand unless you were part of our industry. When she says to me, “You're the only one who has ever made me feel this beautiful,” after she's had such traumatic experience, it's like, yes, this is what I'm supposed to do.

A lot of people think that our industry is about vanity, when it's really so much more than that. I've had elderly women come in and say, “I'm trying to maintain my position in my job market, and I'm trying to compete with 20-year-olds who are just out of college. I’m 70 and I really need this job to continue to live the lifestyle that I do and pay my bills. And the Botox that you gave me just made me feel so refreshed that I went into this interview really confident and I got the job.” Those are the kind of things that make you say, “Wow, that's amazing.” And there are so many more. I mean, I could go on and on. That's where I get inspired. That's what inspires me. It just keeps me wanting to continue to deliver that type of medicine to the heart and the mind with my hands.

Our industry has such a stigma from people who have never had any type of aesthetic procedure done. But when it makes people feel the way that they do, it's incredible. You have almost an instant gratification, positive feedback, and it's very rewarding. And then they continue to pay it forward, and it's the gift that keeps on giving.

destination aesthetics

MM: What do you love about, what do you love most about aesthetics?

SC: On so many levels, I feel like it brings people together because of the way it makes people feel. It's a positive form of self-love and self-care, and I think more people need to focus on that. As people continue to get busier and busier in their lives, and we move away from the personal touch—more towards everything technology-driven and hands-off—it’s great to deliver a personalized service to someone where you are catching them and you are speaking directly at them. It's great to continue to be able to provide a service that is so connected to one another, versus over the computer or iPhone. I love that. It's still kind of old school like that. You can go to the hospital now and be seen by a robot who's basically a doctor on a screen who could be 500 miles away from you. But we're still seeing patients face to face, interacting as we have for generations and not relying on technology to deliver our services. And I love that patient connection.

MM: What do you love about being an entrepreneur?

SC: I love having the flexibility and creativity to develop something that I feel is rewarding to not only myself, but also so many others. I love the freedom to create those ideas that come to your mind, and not have to rely on the corporate structure to make things happen. You can execute on your own terms, and I love that. I just love that freedom and that ability to create.

MM: What advice would you give to other medical spa owners?

SC: Only enter this field if you're truly passionate about aesthetics—don’t be financially driven. Also, nurture your team, yourself and your patients, and have those be the top three priorities, other than your family—obviously that’s number one—but really focus on team-building and personal self-care, and have your outcomes be completely patient-driven and satisfaction-driven.

MM: What would you say is the goal behind your medical spa's design?

SC: The goal is really just to create a well-oiled engine that focuses on patient satisfaction and patient outcomes, and to deliver a brand that is luxurious yet professional and maintain a high level of respect in the community.

The branding is very compatible. All of our interior design and social media and everything, it all encompasses our brand in that it's a luxury medical professional entity. We want it to be a place away from home that feels comfortable and upper-end, but still maintain that professionalism in our community. We're trying to take the medical spa connotation into the next level. It's not anything basic. We want to be everything but basic. We want to be next-level.

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Business and Financials  Med Spa Trends  QP 

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How Do You Name a Medical Spa in New York (And Elsewhere)?

Posted By Administration, Wednesday, August 7, 2019

new york city

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

Choosing a name for a new business is one of the more difficult decisions entrepreneurs have to make, and this is especially true in the medical aesthetic industry. A medical spa needs a unique and memorable name that conjures thoughts of vitality, health and beauty, but it also must follow the rules for naming medical and professional entities. As we’ve discussed in the past, most states consider medical spas to be medical practices, and every state has its own rules or standards when it comes to naming and advertising medical practices.

New York state has particularly stringent rules regulating physician advertising. Fortunately, the New York State Office of the Professions provides a useful resource for navigating the rules for naming a professional entity in the state. While these rules are specific to New York, the concepts are similar in many other states.

The requirement that the name of a professional entity must appropriately describe the profession and the professional service being offered is the first and largest hurdle to overcome. In the medical spa setting, the professional services being offered will be “medicine” or “medical”—or, for independent nurse practitioners, “nursing.” But these terms are very generic and don’t accurately convey the type of experience and services offered in most medical spas. To provide a better description, you might be tempted to use terms such as “aesthetic,” “esthetic” or “anti-aging” to describe medical spa services, but these terms fall under the “specialty area” naming rules in New York. Essentially, if you want to use a special branch of a profession—in this case medicine—the Office of the Professions requires that you submit proof of certification in that specialty practice. While physicians may obtain board certifications in dermatology and plastic surgery, practicing in the area of aesthetic medicine does not come with specialty board certifications.

Could you add “medical spa” to the end of the name for your professional entity? Using the term “medical spa” reflects the required “medical” professional practice area, and “spa” makes it clear to the public what types of aesthetics services you plan to offer. This seems like a good alternative, but, unfortunately, the term “spa” in connection with “medical” are among a list of words specifically prohibited as being misleading in New York. And it isn’t only “misleading” terms that are prohibited: Professional entity names cannot suggest an affiliation with another entity or imply professional superiority. Therefore, whether intentional or not, the chosen name can’t be too similar to the name of another entity, and it also can’t include ideas such as “best,” “advanced” or “expert.”

To add an additional twist, New York medical spas face the same restrictions when choosing an assumed name under which to practice, also known as a “doing business as” or “d/b/a” name. Many states have particular rules in naming the registered professional entity, but they often allow more flexibility in using assumed names. This is not the case in New York—the assumed names of professional entities must follow the same naming requirements.

While New York is particularly strict, each state has its own rules that govern business naming, especially for businesses that provide medical services. Before you spend valuable time and money on signage, web design, advertising and marketing, it is important make sure that you choose a name that complies with your local and state laws. If you want to learn more about effective medical spa marketing and business practices, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps.

Tags:  Business and Financials  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with Eliza Parker, MD, of Cadella Aesthetics and Wellness Center

Posted By Administration, Friday, August 2, 2019

Eliza Parker of Cadella Aesthetics

At Cadella Aesthetics and Wellness Center in Chicago, a medical aesthetic treatment is just part an overall experience that’s designed to help patients not only look better, but also feel better. Practice owner Eliza Parker, MD, recently spoke with AmSpa Content Writer/Editor Michael Meyer about how Cadella came to be and how its customer service helps sets it apart.

Michael Meyer: What inspired you to open your practice?

 Eliza Parker: I really love what I do. So there are a couple things. One, I love the artistic part of aesthetics. It's just so much fun to restore and rejuvenate how people look and feel. I think also, coming from intensive medicine, I love the wellness side of the approach. You're seeing people and you're making them feel good, and they're coming from a healthy place. It was a really nice change. And also, I just love people, and if you like people, this may be one of the best industries to be in, because throughout the day, you meet so many people from different walks of life who are doing different things. It never, ever gets boring. It's so fun.

MM: What would you say is different about your practice now versus when you opened it?

 EP: It's really evolved and developed and grown on all fronts. When you first start, you have a vision—I can keep this so simple, and I'm not going to have to do X, Y, and Z. And then you learn that you have to do X, Y, and Z, and it gets more complicated, but it also gets richer. Experience changes everything—not only with patients, but also with the business and with how you outreach, with how you manage goals and all these various parts of it. And the more people you meet and talk to any industry, the more you see things that you do and don't want to do—I think there are as many don'ts as there are dos. You think, “I don't think that's the way I want to go,” but you have to try. I feel like as you try different things, the business grows really fast. When I first started, I kept it very simple. I had a very straight idea of how I wanted to grow. Now it is at the place where I have this very mature, experienced staff. I have a very well-established business model, and it makes it so when we add something new, we have all this infrastructure to grow with. I think it's just very solid. It's awesome.

MM: What is your most popular treatment?

 EP: It's definitely my liquid facelift. If you just walk into a med spa off the street, you won't be able to get those kinds of long-lasting results. But to actually get a nonsurgical liquid facelift, it changes people's whole perspective of themselves. For me, it's just so much fun because I can take pictures of how they looked 20 or 30 years ago, and we can restore that. They're always so amazed that you can recreate what they were and keep that moving forward, and it definitely brings in the most revenue for sure. I think fillers are an amazing way to make transformational change, and the time it takes to do them is less exhaustive than some of the other procedures.

MM: What would you say is the most important factor to your success?

 EP: Loving what I do and finding staff who love what they do. I have had all of the ups and downs, but when you get people in different positions in your business who truly love to come into work every day, it just naturally grows exponentially. That's, I think, why it's gone in such a positive direction. We have a mission statement—we go through it every team meeting, we all are on the same page and I don't feel like everyone has different goals. We all are working with each other for the same goal, so it works well.

MM: What makes your medical spa different from others?

 EP: It's hard to say, because I don't personally go to a lot of other medical spas, but what I hear from my patients is that they feel like they're really well taken care of. We tend to really try to find out what the patient wants and needs. What is going to make their experience better? It may have to do with us changing their parking position, or it may mean we have to help them get to their next appointment and call ahead. How can we make their day better? We actively try to look at how we can improve not just their Botox experience, but also their life. We truly do care, and I think it comes across, and I think patients feel that way. It's very intimate, and we know everybody. Even though we are very big, we really work hard at making everything very personal.

MM: Who inspires you?

 EP: I'm constantly reading books, and I get them from different people who I'm working with, or one book leads to the next. I think being well informed is always key, but I would have to say the thing that really keeps propelling me is my patients. There's so much information you get every day from every encounter that propels this business, and it is inspirational. You meet people and hear their different stories, and if you really analyze every single one, it can also make you crazy, because if you have a lot of bad experiences you may not feel inspired. But at least for me, most of the time I find my patients extremely inspiring.

It's also my kids. I created this business and used their names—Cadella is a combination of my daughters’ names—and I know this whole business was forged with them in mind; that always inspires me. And working with people who I enjoy working with inspires me. I think it's definitely a lot of factors.

MM: What do you love most about aesthetics?

 EP: A couple things. One, the field is growing daily, so it's very, very fun. There's so much innovation. It's not stagnant or boring. Every couple of months, somebody's got some new product, some new device or some new way of trying to improve the aging process, so it's never boring. I think that every single person you treat reacts or responds slightly differently, so you're applying new algorithms for each person, so it's not boring. Also, you're making people really happy. What's not to love about that?

MM: What do you love about being an entrepreneur?

 EP: It's the best, because you come up with ideas and then you try them out, and you constantly are going for it. When I started, I was so frightened because there are so many big financial risks you take in this field. It's kind of hard to believe that I did it. But you take these financial risks, and then you don't think that failure is an option, and then it doesn't become an option and you just make it work. I think that once you've learned that you can do that, you start applying it to all parts of your life. I think that's one of the best parts, for sure. I love it.

MM: What was your goal with the interior design that you chose?

 EP: It’s just my taste. I love it. I wanted to make it very relaxed and refined for my patients, so when they come here, they feel like it’s private and they can feel safe. I also wanted to make sure they feel that they are not stuck in some random waiting room. I wanted them to feel fairly relaxed, like this is a place that they're welcome to come any time. I wanted to make them feel like it was more than just a medical office—it’s a very safe space and a really pleasant space to be in.

interior design

MM: What advice would you give to other med spa owners?

 EP: If you think it's a get-rich-quick scheme, you are wrong. It is not. You can do very well financially, but it costs a lot. Your motivations for doing it have to be aligned with loving it. If you're doing it because you want to make a lot of money, I just don't think that's a great approach and I haven't seen people who have that attitude do very well. I've seen a lot of people fail at this business and I’ve seen a lot of people succeed, but I've seen more failures than success. So I think you should know, right from the get-go, that this is not a cookie-cutter, easy business to jump into. The patients, the consumers, are extremely savvy. They have a lot of choices. You have to be really good at what you do if you want to be successful, and it's going to take as much time as any other profession to get good at it. It's not easy to find an injector and make a ton of money off Botox—you have to find an amazing injector, and then, over time, you will make money.

Also, talk to colleagues—it needs to happen so much more than it does. I've had the privilege of being in a group of medical spa owners—we meet and talk about our failures and our successes, and it really expedites growth. I think people tend to stay quiet and think that they are coming up with the only solution, and they don't want to share because they want to be the only one to have it. I think that's a really sad approach. I feel like if we're all talking together, everyone moves faster, and patients are going to choose who they want, no matter what you do in your business. There are enough patients for everybody. There's plenty of business out there. It would be so nice if people were more open.

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Business and Financials  Med Spa Trends  QP 

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