Leveraging Aesthetic Devices in Your Practice

The aesthetic devices market is one of the fastest growing markets in the world, and is expected to reach approximately $6.5 billion by the year 2017, according to the Dallas, Texas-based market research firm MarketsandMarkets. 

The societal imperative to keep up with the younger-and-or-more-attractive Jones combined with significant improvements in lasers and other energy-based aesthetic devices has enterprising dermatologists simultaneously avoiding the nuisance of third-party payers and evolving their practices into bastions of self-esteem improvement, in ways that their predecessors in the earlier days of dermatology probably would not have envisioned. 

Aesthetic devices are experiencing technological advancements resulting in high functionality, lower costs, ease of operation, and minimally invasive and non-invasive aesthetic procedures that are fuelling the growth of this market, according to MarketsandMarkets. Dermatologists who are addressing the needs of the marketplace are benefitting from these trends. 

Skin tightening, skin resurfacing, reduction of pigmented skin blemishes and age-related vascular/dermal lesions, as well as hair removal, are among the most popular offerings on the menu of aesthetic dermatologists, and increasingly these services are representing a larger percentage of the balance sheet of savvy clinical dermatologists, as well.

The Laser Effect 

Dermatologists at the helm of some of the leading aesthetic practices in the country have much to share about how lasers and other energy-based devices have helped elevate their practices in an increasingly competitive market. Tina Alster, MD, the founding director of the Washington Institute of Dermatologic Laser Surgery and a clinical professor at Georgetown University Medical Center in Washington, DC, says lasers have impacted her experience as a dermatologist and shaped her practice. 

“My entire practice has been affected by lasers and other non-invasive technologies,” says Dr. Alster. “I founded the Washington Institute of Dermatologic Laser Surgery in 1990, and at that time it was the only freestanding clinical laser facility in the world — outside of a university — that was dedicated to the delivery and advancement of dermatologic lasers.”

Since, then, she explains, she has added at least one new laser or device every year. “Essentially, as soon as a new device was introduced to the market — and sometimes even before devices were available because of clinical study trials performed at the Institute — I would incorporate the new technology into the practice, thereby expanding the range of services provided to my patients,” says Dr. Alster.

Figure 1. Doris Day, MD, notes that procedures can make a positive difference in people’s lives.

For dermatologists who are considering acquiring a new device to initiate or broaden their reach into the cosmetic arena, Dr. Alster advises the most prudent thing to do is to first review one’s patient pool. 

“It is important to identify what type of patients and conditions are most commonly treated in one’s practice. For instance, does someone see patients with photodamaged skin or plan to treat a lot of birthmarks and tattoos? Different lasers and devices are used for different skin conditions, so it’s imperative to hone in on the type of patients one anticipates treating. If a variety of different conditions, such as vascular, pigment and photoaging are anticipated, it would be advisable to investigate the multiplatform devices that can deliver a wide range of different wavelengths, as well as other technologies,” she says. 

David McDaniel, MD, too, stresses the importance of matching the technology to your existing patient base and then growing from there. “If you have the patients already and the need is there, then next make sure to buy the best, safest, most effective device for those applications — from a company that provides good service,” explains Dr. McDaniel, who is the director of the McDaniel Institute of Anti-Aging Research as well as the Laser & Cosmetic Center in Virginia Beach, VA. 

He says recent improvements in fractional lasers have profoundly impacted his practice, and he has just about every type of laser and other energy-based devices that can perform aesthetic procedures. “It’s obvious that I am enthusiastic about the value and usefulness of these devices. Each has a niche,” he says. “I have been very involved in research and development of devices and other clinical studies since the 80s, which has given me tremendous insight into what to offer my patients, as well as early access to the newest technologies. The new picosecond alexandrite laser is a great example of this,” adds Dr. McDaniel. 

Figure 2. David McDaniel, MD, is enthusiastic about the value and usefulness of new technology and says each has a niche.

He shares that new is not always better and that he still uses an intense pulsed light (IPL) device frequently — especially for pigment dyschromia (without much wrinkling) and also for rosacea telangiectasia. “We have a variety of vascular lasers, but our newest IPL we acquired has proven to be as effective as the lasers used for facial telangiectasia,” notes Dr. McDaniel. “I still prefer sclerotherapy for most spider leg veins, but in selected patients various vascular lasers and IPLs works well, too.” 

He says the pulsed dye laser is still an iconic device and he uses it frequently to reduce the duration and severity of bruising after injectables and to treat red stretch marks and certain scars.

Dr. McDaniel notes that radiofrequency and ultrasound devices have also been quite useful in his practice. Skin laxity, wrinkling, body contouring and fat reduction are among the indications. “These devices can be very effective when properly used, and with correct patient selection, they are safe and well-liked by patients,” he says.

Despite his array of equipment, Dr. McDaniel stresses that establishing one’s self as a premium practice in the cosmetic dermatology arena entails more than acquiring equipment. “Having a variety of devices allows customized treatment, which helps minimize side effects, and this really does enhance our reputation for safety and efficacy. However, make sure you get great training and also learn when the devices are best indicated, because achieving great results for your patients with no adverse events is ultimately what will help to grow your practice.” 

Building a reputation as a leading laser practice is ultimately as complex as the relationship between skin and heat: It is about way more than the device. Dr. McDaniel’s formula for building a reputation as an aesthetic “laser” expert: “Buy the best equipment, learn from the most experienced clinicians, attend conferences to keep on the cutting edge, share your knowledge in forums in which you are comfortable, strive for excellence in all facets of patient care and finally never let the business side of aesthetic medicine distract your focus from being a great physician.” 

Cosmetic dermatologist Vic Narurkar, MD, is the founder of San Francisco Bay Area Laser Institute, and like Drs. Alster and McDaniel, he played an integral role in the research that brought the first aesthetic lasers to the dermatology arena, as well as other energy-based modalities that are popular and effective today. He says that when choosing which devices to bring into a practice, there are a couple of critical factors to consider: First, it has to really work; and second, it has to make sense in your practice. 

“There may be technologies that are amazing, but they just don’t fit into the practice. If I were just starting to branch into lasers and other aesthetic devices I would start with a fractional laser and a vascular laser because you can count on results with that technology,” says Dr. Narurkar. 

Figure 3. Vic Narurkar, MD, notes it is important to educate patients on what is available, how it works and keep them informed on new developments with the devices.

“My advice to the new practices, or to those dermatologists who are expanding into cosmetics, is to start with injectables because they are easy investments and then figure out what niche in your practice is unmet. There is always room for a vascular laser in a dermatology practice, and there’s always a need for a resurfacing laser because we deal with photodamage and vascular anomalies. So if I were just starting out, I would invest in a V Beam or an Exel V laser and a Fraxel laser,” he explains.


Building a Reputation

 Figure 4. Tina Alster, MD, has performed some of the earliest research on dermatologic lasers.

Assembling a device arsenal is step 1 on the way to building a premium aesthetic dermatology practice. Step 2, says Dr. Alster, is building a reputation. “The best way to build a reputation as an aesthetic laser expert is to perform clinical studies and report on them in scientific journals and at professional meetings. I was fortunate to have had the opportunity to perform some of the earliest research on dermatologic lasers. As such, I was able to lecture and publish widely in the field, which helped to enhance my professional reputation. Simply stating that one has treated ‘hundreds’ or ‘thousands’ of patients does not make one an expert in the field,” she explains.

Doris Day, MD, who specializes in laser, cosmetic and surgical dermatology in New York City, at Day Dermatology & Aesthetics, says lasers and other energy-based devices provide a more complete portfolio of treatment options for her patients. 

“I’ve been in practice almost 17 years, and I have 15 devices. I still use (an updated version) of the first one I acquired. These days we don’t have to get a new device every year because there are platforms that are expandable so we can have the same device do more than one thing,” she says. 

“However, I find that that is not necessarily ideal. If I have an IPL separate from my CO2 [carbon dioxide] separate from my red laser, separate from my tightening laser then my staff and I can all use the different devices at once, and that can generate income and treat a broader range of patients,” she adds. 

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