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					   New Breed of Aesthetic Practices

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300 Aesthetic Buyers Guide Primary Care Edition Spring 2007
to Success

    As primary care physicians make the decision to add cash-pay elective aesthetic proce-

dures to their practices, they must navigate the key business decisions involved with this tran-

sition. Choosing the right technologies for your practice, based on patient demographics and

local market conditions, is essential to success. In the following case study profiles, physicians

share their personal experience and offer proven advice on strategies to win in the prosper-

ous new aesthetic market.

                                                          Aesthetic Buyers Guide Primary Care Edition Spring 2007 301
                                                             Red Alinsod, M.D.                                    session. Treating the bikini line starts at
                                                             Laguna Beach, California                             $125, with a fifth session free. Fractional
                                                                                                                  treatment of fine lines and wrinkles with the
                                                                Trained as a pelvic surgeon, Red Alinsod,         StarLux 1540 nm handpiece is $1,200,
                                                             M.D., has used lasers for aesthetic vaginal          and a package of three sessions is $3,000.
                                                             surgery since 1991. But only in the past
                                                             three years has he expanded into cosmetic              “The learning curve is not steep with the
                                                             dermatology. “I augmented the practice               new technologies and they have become
                                                             because of requests from women I had                 much safer,” Dr. Alinsod stated. “It’s nice
                                                             already treated vaginally,” said Dr. Alinsod,        to have both an insurance and cash busi-
                                                             director of South Coast Urogynecology, Inc.          ness. Over the next few years, I suspect
                                                             in Laguna Beach, Calif. “These women                 non-vaginal aesthetics will represent about
                                                             were all going to the dermatologist or the           50% of my practice. We haven’t even
Red Alinsod, M.D.                                                                                                 actively marketed these procedures. I wish
                                                             plastic surgeon for additional procedures
Director                                                                                                          I had entered this field ten years ago.”
                                                             after I had seen them. Having years of expe-
South Coast Urogynecology, Inc.                              rience with lasers, I didn’t feel it was that big
Laguna Beach, CA                                             of a leap to treat skin.”                              In-house patients are good candidates.
                                                                                                                  “Many of these patients are too shy or
                                                                Dr. Alinsod estimates that 25% of his             afraid to approach a dermatologist or
                                                             current practice is non-vaginal aesthetic            plastic surgeon. But these patients feel
                                                             procedures. “Being located in a beach                comfortable having these procedures per-
                                                             city, photofacials are probably my most              formed by their primary care doctor,” Dr.
                                                             popular,” he said. “I also do a lot of hair          Alinsod said. “Patients may also feel a stig-
                                                             removal,         primarily   the   bikini   line.”   ma attached to seeking treatment by a spe-
                                                             Through The Laser Network, LLC (Morrison,            cialist. Likewise, doctors may feel a stigma
                                                             Colo.), Dr. Alinsod has purchased two                from other doctors. But that’s ridiculous.
                                                             new Palomar (Burlington, Mass.), StarLux             Use your skills. It is not an admission that
                                                             pulsed light and laser systems over the              your practice is not doing well. It is actual-
                                                             past six months to replace his older equip-          ly a declaration that you are independent
                                                             ment. “The StarLux is supremely comfort-             and can do more for your patients.”
                                                             able for patients. They come back. The
                                                             pain is minimal compared to other systems
                                                             that I’ve used.”                                     Edward Zimmerman, M.D.
                                                                                                                  Las Vegas, Nevada
                                                                Dr. Alinsod is highly impressed with how
                                                             attentive and detailed The Laser Network is            A roll of the dice in aesthetics has
                                                             about his practice and matching him up               proven lucrative for Edward Zimmerman,
                                                             with the best system. “They were able to find        M.D., a cosmetic surgeon in private prac-
                                                             a great deal for me with the StarLux. They           tice in Las Vegas, Nev., who started out in
                                                             went straight to the manufacturer,” he said.         family medicine. “I suggest that doctors
                                                                                                                  begin with Botox (Allergan, Irvine, Calif.),
                                                                For a single photofacial treatment the            and minimally invasive office procedures
                                                             practice charges about $475, while a                 like superficial resurfacing and facial fillers
                                                             package of four sessions includes one free           of all kinds,” he commented.

302 Aesthetic Buyers Guide Primary Care Edition Spring 2007
  Training is important, too. “There are         explanations to the patient. Staff should be
many training institutes. Get the training       cordial, yet happy. We want every patient
that will enable you to live the plan you’ve     to feel special.”
mapped. You should also document every-
thing you do, so you can learn from it,” Dr.
Zimmerman noted. “Marketing is also crit-        Gale Lawrence, M.D.
ical. We tried TV a number of years ago.         Seal Beach, California
It didn’t work out. But we’re trying it
again.” For marketing liposuction, the             It was her own patients who motivated
practice has posters and brochures at high-      Gale Lawrence, M.D., a family medicine
end, 24-hour-a-day fitness centers.              physician from Seal Beach, Calif., to enter
                                                 the aesthetic arena seven years ago. “My
  One of the new technologies Dr.                patients wanted me to do Botox,” Dr.
Zimmerman has acquired over the past             Lawrence recalled. “The patients knew me
                                                                                                                       Edward Zimmerman, M.D.
year for body contouring is the CoolLipo         and trusted me. They didn’t want to go to
                                                                                                                              Cosmetic Surgeon
from CoolTouch Inc. (Roseville, Calif.),         someone else.” Plus, there is the conven-                                       Las Vegas, NV
which is a 1320 nm, 15 watt laser that           ience to both patient and practitioner. “I
employs a fiber optic waveguide through a        can take care of both aesthetic and med-
tumescent needle to bring pulsed energy to       ical concerns during the same visit,” Dr.
the fat cells. “The photoacoustic effect actu-   Lawrence said.
ally pops the fat cells.”
                                                   Currently, about 35% of the practice is
  Dr. Zimmerman’s practice charges               cosmetics. Besides Botox and facial fillers,
$3,000 to $3,500 for a single session of         patients can schedule microdermabrasion
the CoolLipo for the first body area. “But       and photofacials. Dr. Lawrence uses the
you have to choose very carefully as to          Quadra Q4 intense pulsed light (IPL) sys-
the procedures you offer, by looking at          tem and the microdermabrasion system
both the demographics in your particular         from DermaMed USA, Inc. (Lenni, Penn.)
area, including age and income, and the          for treatments. “The Quadra is very effec-
competition,” Dr. Zimmerman explained.           tive and easy to use for pigmented lesions
“It is very difficult to market if your com-     and photorejuvenation,” Dr. Lawrence con-
petitor is using a similar system for the        veyed. Most patients schedule three to six
same indication.”                                sessions, one month apart.

  Personality of the staff can also give your      “I can check for skin cancer at the same
practice an edge. “Obviously, the tenor of       time that I perform a photofacial,” said Dr.
a practice runs from the top down,” Dr.          Lawrence, who charges $75 to $150 for a
Zimmerman said. “Thus, if you really bend        single session of chemical peel/microder-
over backwards to do the right things for        mabrasion. “I would start in aesthetics with
your patients, your staff will treat patients    microdermabrasion because it is very safe
the same way. Taking lots of before and          and effective.” Doctors are also able to test
after images to gauge progress will make         the waters before making a larger commit-
patients happy with their care. It’s sort of a   ment. “After microdermabrasion, I would
Neiman Marcus approach, with detailed            suggest chemical peels,” Dr. Lawrence said.

                                                                                   Aesthetic Buyers Guide Primary Care Edition Spring 2007 303
                                                             “But you really need to like Botox because        it will show in your work. Both facial fillers
                                                             you are spending a lot of time with the           and liposuction involve sculpting. Being
                                                             patient. You also need to think like the          able to visualize the outcome before you
                                                             patient. The patient doesn’t always see what      get there is important.”
                                                             you see. Botox is not merely technique-driv-
                                                             en. There is a strong artistic side.”               Liposuction, laser tattoo removal, laser
                                                                                                               facial rejuvenation, facial fillers and injecta-
                                                                Dr. Lawrence is extremely careful about        bles are the laser center’s most popular
                                                             the procedures she offers “because they           procedures.
                                                             have to work. If not, patients will not con-
                                                             tinue to come back year after year.”                Hoya      ConBio’s     (Fremont,     Calif.),
                                                                                                               MedLite C6 Q-switched Nd:YAG laser is
                                                                Furthermore, Dr. Lawrence performs all         for tattoo removal and facial rejuvenation.
Donald Rainone, M.D.                                         procedures herself, without a staff,              “There are four wavelengths,” Dr. Rainone
Smoothskin Cosmetic Laser Center                             “which tremendously reduces overhead. It          explained. “I use the 1064 nm wavelength
Londonderry, NH                                              is very expensive to hire a nurse practi-         for wrinkles, tightening and skin texture.
                                                             tioner or nurse, or even a physician assis-       For skin color or complexion, I use the 532
                                                             tant.” The practice also sells a lot of cos-      nm green light.” The MedLite also has two
                                                             meceuticals      (facial   washes,      toners,   filtered handpieces. “The 585 nm and 650
                                                             creams). “These are easy sales,” Dr.              nm wavelengths enable me to treat the
                                                             Lawrence said. “Patients trust that you will      greens and the turquoise inks that are elu-
                                                             choose the appropriate products. Adding           sive to other wavelengths,” Dr. Rainone
                                                             aesthetics is simply another aspect of            said. For tattoo removal Dr. Rainone
                                                             medicine that helps make your practice            charges on average $300. Most patients
                                                             more interesting.”                                schedule six sessions, four weeks apart.

                                                                                                                 Dr. Rainone’s laser center markets its
                                                             Donald Rainone, M.D.                              procedures through a TV commercial and
                                                             Londonderry, New Hampshire                        frequent updates to it’s website. “We are
                                                                                                               on a main road with high visibility, so we
                                                                Ever expanding cosmetic possibilities          also have a message board in front of the
                                                             from improved technology led Donald               building,” Dr. Rainone said. Catchy phras-
                                                             Rainone, M.D., to change from practic-            es such as “Hair Today, Gone Tomorrow”;
                                                             ing internal medicine to aesthetics full          “Lines, Spiders and Hairs…Oh, My”; and
                                                             time in 2001.                                     “A Slimmer You Is Liposuction” are thought
                                                                                                               up by Dr. Rainone himself and changed
                                                                “But physicians should enjoy aesthetic         about twice a week. “Twenty thousand
                                                             medicine, rather than running away from a         cars pass the sign each day, and half of
                                                             practice they don’t like. I have seen col-        my new patients are from drive-bys,” he
                                                             leagues enter aesthetics simply as an             noted. “I truly love what I do — getting up
                                                             escape,” said Dr. Rainone, co-owner of            in the morning and coming in. In fact, I
                                                             Smoothskin Cosmetic Laser Center in               miss it when I am not working. I truly have
                                                             Londonderry, N.H. “You also need to have          a passion, which I hope others entering the
                                                             an artistic bent. Patients will know because      field will find.”

304 Aesthetic Buyers Guide Primary Care Edition Spring 2007
Johnny Farrow, M.D.                              date. I would definitely research and talk
                                                                                                                “You’re not going
Manteo, North Carolina                           to other physicians before simply relying
                                                 on the company’s information.”                                        to step into
  Although trained in emergency medi-
cine, Johnny Farrow, M.D., had the oppor-          A patient who visits an aesthetic practice                      aesthetics and
                                                 also has a different mindset, observed Dr.
tunity to return home to Manteo, N.C., to
practice outpatient medicine because there       Farrow. “This is a cash driven business, so
                                                                                                               automatically start
was no local hospital. “However, after           patients are there because they want to be
                                                 there, not because they need to be there,”
                                                                                                                  making money.
about three years of family practice, I
missed doing procedures,” said Dr.               he said. “Therefore, the staff needs to keep                    There may be a
Farrow, who entered aesthetics in 2001.          things moving on time, as much as it can.
“We treat sun damage, melasma and wrin-          Some of these patients can also be demand-                      large investment
kles. We also do laser hair removal, scle-
rotherapy and laser leg vessels.”
                                                 ing at times. In general, patients expect a
                                                 higher level of service and customer satis-
                                                                                                               in both equipment
                                                 faction because these are elective proce-                              and time.”
  To document patient outcomes and               dures. We are a staff of true caring.
increase patient satisfaction, Dr. Farrow
uses both the VISIA Complexion Analysis            Dr. Farrow attributes his success in aes-
and the OMNIA Imaging System from                thetic medicine to persistence. “It takes
Canfield Imaging Systems (Fairfield, N.J.).      time and a lot of work. But you’re not
He also uses Canfield’s Mirror imaging           going to step into aesthetics and auto-
software with aesthetic simulation that is       matically start making money. There may
integrated with the OMNIA. “When a               be a large investment in both equipment
patient comes in for initial consultation, the   and time.”
aesthetician is able to do the VISIA com-
plexion analysis,” Dr. Farrow conveyed. “I
can then consult with the patient, who can       Valerie Fox, M.D.
see objectively, through pictures, some of       Clarkston, Washington
the conditions we treat. You are able to be
diplomatic with the patient about their            It was her own up close and personal
imperfections and aging conditions. As a         experience with aesthetics that convinced
result, the number of procedures I perform       Valerie Fox, M.D., to embark on aesthetics
has increased considerably.”                     last spring. “I was starting to notice some
                                                 aging within my own skin,” said the 38
  Dr. Farrow, who now devotes 40% of his         year old family physician. “I went for a
time to aesthetics, admitted he has always       consultation and learned about the tech-
been too hasty in making purchasing deci-        nology and the ease of the procedures. I
sions. “When I see something that is the         underwent a small laser procedure and
latest and greatest out there, I buy it,” he     was impressed by the minimal downtime
said. “But then one year later, I feel I need    and impressive results. But I also was
to purchase something even greater. It is        enticed to take out my credit card and
easy to get caught up in the technology          sign up for the biggest package possible.
and overspend. If you are not careful, the       I think cosmetics is something that we, as
equipment can quickly become out of              women, desire.”

                                                                                  Aesthetic Buyers Guide Primary Care Edition Spring 2007 305
                                                                Today, about 35% of Dr. Fox’s practice         house also served wine and gave atten-
                                                             is aesthetics, which complements her fami-        dees a discount on services. In addition,
                                                             ly medicine in Clarkston, Wash. “For that         Dr. Fox has spoken at several professional
                                                             third of my time, it doubles my income. But       organizations, like the Dental Hygienist
                                                             it was very intimidating at first because of      Society. “We have also donated services
                                                             the large cash outlay.” It helped, though,        to charitable auctions, such as the Boys
                                                             that her average family medicine patient          and Girls Club,” she said. “Our largest
                                                             was a 45 year old woman.                          donated package has been $4,500,
                                                                                                               which was auctioned for the full value.”
                                                                Dr. Fox’s medical spa has its own              Some of the attendees at these auctions
                                                             entrance and the suite is decorated in            end up at the spa for treatment.
                                                             Italian motif. “It is very classy and upscale.”
                                                             Among the offerings are photorejuvena-              “This is the best thing I have ever done,”
Fiona Wright, M.D.                                           tion, Botox, hair removal and fractionated        Dr. Fox stated. Apart from the financial
Family Practitioner                                          resurfacing. “I thought clients would have a      rewards, “I can’t believe how much better
Plano, TX                                                    certain expectation,” Dr. Fox said. “But I’ve     these women feel on the inside when the out-
                                                             had to learn to tell clients what services to     side is improved. It is amazing what cosmet-
                                                             purchase. I’ve had to become more                 ic procedures do for women’s self-esteem.”
                                                             assertive. Physicians, in general, tend to
                                                             not be great salespeople. However, these
                                                             clients are coming to us for our profession-      Fiona Wright, M.D.
                                                             al opinions and recommendations. Multiple         Plano, Texas
                                                             procedures are common.”
                                                                                                                 Fiona Wright, M.D., used to practice fam-
                                                                Resurfacing is performed with the multi-       ily medicine full time. Then in about 1999,
                                                             platform Harmony laser from Alma Lasers,          she began splitting her time between family
                                                             Inc. (Buffalo Grove, Ill.). “You have the         medicine and aesthetic medicine. Since
                                                             ability to interchange wands. We own              2004, the Plano, Texas based physician
                                                             about seven handpieces, including the             has devoted full time to aesthetics.
                                                             Pixel for fractionated resurfacing,” Dr. Fox
                                                             explained. “On the other hand, the 540 nm           “I was trained in aesthetics during my
                                                             wavelength lifts up some pigments. The            residency,” Dr. Wright said. “I went full
                                                             Harmony also has a skin tightening wand.”         time because of the demand. I could not
                                                                                                               dedicate myself to both practices. I am so
                                                                Alma’s Soprano laser, is used for hair         glad I chose aesthetics. I haven’t looked
                                                             removal. “A lot of our clients have had hair      back at my decision.”
                                                             removal done with other lasers. They say
                                                             ours is much less painful and much more             At the Aesthetic Institute of Plano, a full
                                                             effective,” Dr. Fox said. For the upper lip,      spectrum of services are offered, including
                                                             patients are charged $249 for six sessions.       all spa services, body contouring, facial
                                                                                                               injectables and laser rejuvenation. The
                                                                Besides promoting procedures on their          Whisper Er:YAG laser from Radiancy, Inc.
                                                             website, the first open house attracted           (Orangeburg, N.Y.), for skin rejuvenation
                                                             “about 120 people and generated about             “has predictable results that I can guaran-
                                                             $50,000 in sales,” Dr. Fox said. The open         tee a patient,” Dr. Wright related. “This

306 Aesthetic Buyers Guide Primary Care Edition Spring 2007
laser is also a good alternative for patients      of money they do, they want to know that
who desire both pigmentation and textural          there is a physician who will walk them
                                                                                                                     “You also need
improvements. Other laser procedures for           through the whole process.”                                   to have a passion
these indications create more downtime.”
                                                     Dr. Wright stressed that to truly be suc-                         for aesthetics,
  Practitioners need to have confidence in         cessful in aesthetics, “you should give it
the light-based systems they acquire,              100% of your time. If you practice aesthet-
                                                                                                                  rather than simply
according to Dr. Wright. “I think there are
a lot of systems out there that try to oversell,
                                                   ics only two days a week, you really can’t
                                                   be available to those clients. You also need
                                                                                                                 having an existing
but underproduce. To be successful, you            to have a passion for aesthetics, rather than                        patient base.
need to undersell and overproduce,” she            simply having an existing patient base.
said. “I test every device that I eventually       Your infectious enthusiasm for the proce-                          Your infectious
purchase, so I know exactly what it does
and what I can offer my patients. Setting a
                                                   dures will trickle down to your patients.”
                                                                                                                      enthusiasm for
realistic expectation for the patient will                                                                           the procedures
make that patient comfortable with you and         Denise Baker, M.D.
you will grow by word-of-mouth.”                   Bradenton, Florida                                               will trickle down
  Dr. Wright paid about $40,000 for the              When the medical liability insurance cri-
                                                                                                                   to your patients.”
Whisper laser, which she purchased by              sis reached a peak in Florida several years
credit card, but paid off quickly. She             ago, Denise Baker, M.D., an OB/GYN in
charges patients $500 for a single session         private practice in Bradenton, Fla., was left
or $2,500 for a series of five treatments          holding the bag. Her insurance company
(every three to six weeks, depending on            skipped town. Ever increasing premiums
treatment aggressiveness). Scheduling 40           forced her to augment her practice with
patients for the package “allows you to            aesthetics.
pay off the entire purchase price of the
laser,” Dr. Wright noted.                            Today, Dr. Baker devotes two days a
                                                   week to gynecology, and the remaining
  Concerning the hiring process at the             three days to aesthetics. Her most popular
institute, the staff is actively involved. “I      cosmetic procedures are Botox, facial
usually have a candidate come in for at            fillers and lasers. In addition, “liposuction
least one day for a work interview,” Dr.           is coming on like gangbusters,” Dr. Baker
Wright said. “This way we can gauge                said. “I have the most delighted, ecstatic
whether that person will blend with us and         patients you could imagine.”
if we blend with them. The candidate also
gets an idea of how busy we are.                     Dr. Baker admitted, though, that her first
Foremost, we look for people who can pro-          two laser acquisitions “were costly mistakes.
vide high-quality patient care.”                   Even though I had been a laser surgeon
                                                   since the mid 80s, I went with a single plat-
  Marketing and advertising materials at           form laser. Within three months, I was more
the Aesthetic Institute of Plano mention the       frustrated by what I could not do with my
fact that Dr. Wright herself conducts              stand-alone Nd:YAG laser than what I could
patient consultations. “This is comforting to      do. Hence, I highly recommend a multi-plat-
a patient. With people paying the amount           form because a small private practitioner

                                                                                     Aesthetic Buyers Guide Primary Care Edition Spring 2007 307
                                                             simply cannot afford the capital outlay           a wellness staff,” Dr. Baker noted. “But
                                                             required for five or six lasers.”                 they are two different businesses. One is
                                                                                                               insurance run and the other is retail run.”
                                                                In order to select the best multi-platform
                                                             system, “research and educate yourself,”            According to Dr. Baker, your aesthetics
                                                             Dr. Baker stressed. The flexible Profile sys-     staff needs to integrate a business sense
                                                             tem from Sciton, Inc. (Palo Alto, Calif.)         with confidence when discussing various
                                                             includes the Contour laser (2940 Er:YAG)          procedures with patients. “The staff also
                                                             for performing the MicroLaserPeel. “Patients      needs to be good about follow-up and
                                                             achieve such a dramatic response in a very        hear what the patient is saying.” Staff can
                                                             short period of time. Unlike with my chemi-       communicate with the patient through ges-
                                                             cal peel, I can tell patients their exact heal-   ture or facial expression. “Staff members
                                                             ing course and downtime.”                         need to be people oriented and enjoy
Denise Baker, M.D.                                                                                             working with the public,” Dr. Baker said.
OB/GYN                                                          Dr. Baker’s practice charges $450 for
Bradenton, FL                                                an arctic peel and roughly $1,600 up to             By integrating aesthetics into her prac-
                                                             $4,000 for a single session of other laser        tice, Dr. Baker has observed “dramatic
                                                             peels. For Botox, pricing typically ranges        changes in the personality of my patients
                                                             from $350 to $500 for a single session.           and a blossoming of their social self. We
                                                             “Men are charged slightly more because            give them an inner sense of confidence.
                                                             of their bulkier muscles,” Dr. Baker said.        This makes patients healthier overall.
                                                                                                               When patients feel better about them-
                                                                Basically, the practice has a separate         selves, they become more energetic,
                                                             staff for aesthetics. “We made the mistake        increase their exercise and participate
                                                             of trying to transform our medical staff into     more fully in life.”

                                                                 C O N TA C T S :

                                                                 Red Alinsod, M.D.                             Gale Lawrence, M.D.
                                                                 voice: (949) 499-5311                         voice: (562) 596-4244
                                                                 fax: (818) 743-7424                           fax: (562) 596-1927
                                                                 email:                         email:

                                                                 Denise Baker, M.D.                            Donald Rainone, M.D.
                                                                 voice: (941) 748-6161                         voice: (603) 434-5510
                                                                 fax: (941) 761-2978                           fax: (603) 434-5509
                                                                 email:               email:

                                                                 Johnny Farrow, M.D.                           Fiona Wright, M.D.
                                                                 voice: (252) 473-9487                         voice: (972) 867-3223
                                                                 fax: (252) 473-1222                           fax: (972) 519-9717
                                                                 email:                        email:

                                                                 Valerie Fox, M.D.                             Edward Zimmerman, M.D.
                                                                 voice: (509) 751-5400                         voice: (702) 360-6686
                                                                 fax: (509) 751-5404                           fax: (702) 360-0128
                                                                 email:                  email:

308 Aesthetic Buyers Guide Primary Care Edition Spring 2007