Palomar Starlux IPL: Notes from a MedSpa owner

Hair Removal Methods Laser hair removal
1

A reader writes

I own a MedSpa in South Florida and I’ve been pouring through your website which is very informative however I don’t believe has accurate information on the Palomar Starlux as compared to true lasers. I’m attaching a study by Amin & Goldberg from late last year that demonstrated no statistical difference between the Starlux Rs and the LightSheer or Gentlelase. The subjects were all men and the area treated were their backs.

We’ve been open for one year and in that time have treated 237 clients for hair removal in every area. To date we have only had two clients that we were unable to achieve an 80% hair reduction and they were both of Indian descent. Most clients are achieving 90% all within 4-6 treatments. I spent 9 months traveling the Country & Canada and visited 35 centers and over 100 Derm and Plastic Surgeons plus met with R&D teams and senior executives from every Laser Company in existence in 2005 before purchasing a
Starlux. I’m a former C.O.O. which afforded me great access to these companies. I will agree that most of the IPL’s do not work very well with hair removal. The Starlux however in the proper hands is at least as good as the two Laser gold standards and is unquestionably more comfortable. Add in PhotoFacials, broken vessels and the new Fraxel which is amazing and Palomar stands alone which is why their stock trades almost double anyone
else’s. It’s also why Gillette which spent two years in an evaluation of technology in the industry chose Palomar for its soon to be released home laser razor. I also own a VelaSmooth (also great results in the proper hands) from Syneron so I’m not a Palomar cheerleader but rather someone who has taken his time to bring in the best equipment money can buy to provide service to our clients.

And a follow-up:

Thanks for the reply and yes, if you would be so kind as to post my comments and the study I’d appreciate that. This industry is about constant change especially with lasers and above all the person who operates the laser. Take any 10 people and have the same machine but two different operators and you will see up to a 30% variance from to the next. It’s not a simple as set it and forget it. The operator has protocols they follow however they also need to take a complete patient history and then gauge the visual evidence to make a proper Fitzpatrick diagnosis. Even then they have a range of up to 6-10j in which to make a call. Up to high and you get a burn. Down to low and you have poor results. The other point is patients lie or at least at times seem forgetful. We’ve had many patients who come in for laser hair and tell us the have had not sun in the past 2 weeks. We ask that question plus the patient fills out a form at least 3 times. Then before we are just about to proceed it’s asked one last time except the potential for a burn is emphasized. About 25% of patients then have an awakening and we reschedule the procedure.

2

Journal of Cosmetic and Laser Therapy. 2006; 8: 65-68
ORIGINAL ARTICLE
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Clinical comparison of four hair removal lasers and light sources
SNEHAL P. AMIN & DAVID J. GOLDBERG
Skin Laser and Surgery Specialistsof NY & NJ, and The Mount Sinai Schoolof Medicine, New York, NY, USA
Abstract
Background and objective:There are few clinical studies directly comparing the efficacy of multiple hair removal systems in
the same individual. This study evaluates the efficacy of four highly popular systems for laser hair removal. Methods: In this
prospective comparison study, 10 subjects underwent treatment of unwanted hair on the back or thigh. Subjects were skin
types I-III, aged 18-55 years. All were treated twice with (1) an intense pulsed light with a red filter; (2) an intense pulsed
light with a yellow filter; (3) an 810 nm diode laser; and (4) a 755 nm alexandrite laser. Four treatment areas, using
commonly accepted parameters for permanent hair reduction, as well as a control non-treated area were selected. Each
treatment area was evaluated with a camera system specifically designed for hair counts at 1, 3, and 6 months after the
second treatment by a blinded non-treating physician. Clinical results and adverse events were also noted. Results:
Evaluation of photographs at 1,3, and 6 months revealed a significant decrease in hair counts (-50%) and hair coverage
(-55%). In the hairs that remained after two treatments, no statistical difference was noted in hair length or diameter.
There was no statistical difference in efficacy between the four different light devices. Minimal transient adverse effects were
noted from all systems. The cryogen spray-based alexandrite laser showed the highest pain scores. Conclusion:Although hair
removal with commonly used systems is, as expected, highly effective, treatment with light-based devices can cause less
pain, yet show efficacy similar to laser systems.
Key words: Hair Removal, Lasers, IPL
Introduction
Hair removal with lasers and light-based devices is
commonly performed in most dermatology practices.
Lasers such as the alexandrite and 810 nm
diode devices are generally considered to be equivalent
.in efficacy and safety (1,2). Intense pulsed light
(IPL) devices have also been widely reported as
effective for hair removal or reduction. Few studies
have directly compared the long-term outcomes of
lasers with IPL devices (3-5). This study was
undertaken as a prospective clinical comparison of
four hair removal devices. Information on hair
counts, hair diameter, hair length, hair coverage
and growth rate was collected through digital
photography and computer analysis. Adverse events
and patient perceptions were also recorded.
Methods
The study period was from August 2004 to May
2005. Ten subjects were enrolled in the study. IRE
approval was obtained prior to subject enrollment.
Informed consent from all patients was recorded.
Inclusion criteria included age 18-65 years,
Fitzpatrick skin types I-III and the presence of dark
hair on the legs or back.
Exclusion criteria for the study were pregnancy,
use of photosensitizing or anticoagulant medication,
diabetes, history of keloid formation, recent oral
retinoid use, active dermatosis within the treatment
area or severe illness. Candidates with previous hair
laser treatments within the treatment areas were
excluded. The study subject profile is listed in
Table I.
Four different light devices were utilized in this
study. All devices were FDA-cleared for hair
removal. Parameters for treatment were selected
based on prior experience with each device and
manufacturer’s recommendations. Table II outlines
all the devices and the utilized treatment settings.
This study entailed a prospective controlled and
blinded protocol. Subjects were selected and test
spots were performed only in those with Fitzpatrick
skin type III. No adverse events were noted during
the spot test phase. Treatment sites were then
Table I. Patient profile.
Parameter Number of patients
Total subjects
Female sex
Non-Caucasian
Fitzpatrick skin types
10
8 (80%)
4 (40%)
lor II (40%); III (30%)
selected by the investigator based on density, length,
and diameter of hair on the legs or back. A brief
description and history were recorded for each
patient including age, sex, skin type, recent sun
exposure, allergies, medications, history of major
illnesses, and presence of a tan or other pigment
changes at the treatment site.
Baseline photography was performed in all subjects.
Skin was shaved and treated in 5 x 5 cm
squares with the four different light-based devices
as depicted in Figure 1. The control square was
shaved but not treated. Areas not being treated with
a particular laser were covered with an opaque
plastic plate to prevent inadvertent laser exposure. A
template of the treatment areas was recorded on a
plastic transparency. The locations of at least three
skin markings were also recorded. ,(Three or more
nevi were used to track the precise locations of
treatment areas.) Shaving and treatment were
repeated at day 30. Slight overlap with all light
devices was performed during treatment to ensure
complete coverage. Only two treatments were
performed. No topical anesthesia was applied. Pain
scores were recorded for all subjects.
During the post-treatment evaluation phase of the
study, control and treatment squares were shaved 14
days prior to photography, which was conducted at
days 60, 120 and 210. Figure 2 summarizes the
study protocol.
Photography was conducted with two different
cameras. Non-polarized images were recorded with
a Nikon 4300 digital camera in 5 x 5 cm fields with a
metal spacer adjusted at 20 cm. Polarized images
were recorded on a Nikon 5000 with a metal spacer
adjusted at 25 cm. A plate of clear glass was affixed
to the end of the spacer, thus blanching the skin. An
example image from each photographic system is
shown in Figure 3.
A non-treating physician trained in hair counting
in a blinded fashion performed all hair measurements.
All hair counts are reported as mean hairs per
square centimeter. Hair diameter is reported as
mean hair diameter (11m) for all hairs in the
photograph. Hair length is reported as mean hair
length (mm) for all hairs in the photograph. Hair
coverage was calculated by computer analysis of the
polarized photographs. The ratio of hair coverage
represents the total number of dark pixels to the total
number of pale pixels. For example, a low ratio may
be calculated if there are few thick hairs or many thin
hairs. Statistical significance was evaluated with
Student’s t-test.
Results
All four light and laser devices resulted in long-term
hair reduction. Hair counts within the treatment
areas and control area prior to any shaving or laser
application showed similar numbers of hairs. The
hair count was statistically reduced at day 210 with
all four light devices by almost 50% from initial
values (Figure 4). There was no statistical difference
between the different light-based devices in the
amount of hair count reduction. Hair measurements
at days 60 and 120 were similar (not shown).
Hair diameter was slightly, but not statistically
significantly decreased (Figure 5). Hair length was
essentially unchanged throughout the study
(Figure 6). The total number of hairs was statistically
decreased. Hairs that still grew after the prephotographic
shaving were normal in diameter and
length.
Hair coverage, or hair part, is a parameter that
evaluates the combined diameter, length and number
of hairs via computer analysis (Figure 7). A low
ratio suggests thinner, fewer or shorter hairs. A high
ratio suggests thicker, numerous and longer hairs.
There was a statistically significant change after two
treatments with all four devices. There was no
statistical difference between the four devices.
Although similar in efficacy, the four devices
varied in their pain intensity, as reported by the
study subjects (Table III). Both the IPL II (35 JI
cm2) and the 810 run diode laser (28 J/cm2) caused
minimal pain during the treatment session on a scale
of 0 to 10. In general, the devices utilizing contact
cooling appeared to cause less discomfort.
The treating physician evaluated immediate and
delayed responses. The most relevant events are
described in Table IV. All patients were noted to
have erythema but only those treated with the lasers
showed perifollicular edema. No patients had
blisters or any permanent side effects.
Discussion
I
I’
The lasers and light devices used in this prospective
blinded and controlled study showed similar longterm
efficacy. An attempt was made to use clinically
effective and similar treatment settings with the two
lasers. The large number of available IPL devices
makes choosing appropriate parameters somewhat
more difficult. Less experience is published with the
IPL devices, especially the Starlux Rs device. A
significant reduction in hair number after two
treatments was expected and confirmed by the
computer analysis that showed decreased hair coverage
at the end of the study as compared to the control
area. Interestingly, hairs that did grow after the two
treatment sessions were not thinner or shorter.
Without the use of topical anesthetics, patient
preference might be based on pain level during the
treatment session. The alexandrite laser was the only
laser in the study with a cryogen spray. Increased pain
perception may be explained by this difference in
hardware. This study confirms our general clinical
experience that lasers and light devices have similar
outcomes in patients with skin types I-III.
References

  1. Liew SH. Laser hair removal: Guidelines for management.
    Am J Clin Dermatol. 2002;3:107-15.
  2. Lask G, Eckhouse S, Slatkine M, Waldman A, Kreindel M,
    Gottfried V. The role of laser and intense light sources in
    photo-epilation: A comparative evaluation. J Cutan Laser
    Ther. 1999;1:3-13.
  3. Marayiannis KB, Vlachos SP, Savva MP, Kontoes PP.
    Efficacy of long- and shon pulse alexandrite lasers compared
    with an intense pulsed light source for epilation: A study on
    532 sites in 389 patients. J Cosmet Laser Ther.
    2003;5: 140-5.
  4. Bedewi AF. Hair removal with intense pulsed light. Lasers
    Med Sci. 2004; 19:48-51. Epub 2004 Jul 1.
  5. Eremia S, Li C, Umar SH. A side-by-side comparative study
    of 1064 nm Nd:YAG, 810 nm diode and 755 nm alexandrite
    lasers for treatment of 0.3-3 mm leg veins. Dermatol Surg.
    2002;28:224-30.
3

I would like to reply to this.

There is no question that IPLs can remove hair and can be pretty effective for the majority of people. But this is true for every laser. The problem is that after numerous treatments their limitations begin to add up and the problem is that much of the testimonials and studies to support their claims are somewhat deceiving.

I can not speak directly about the Starlux as I have not used one personally but I owned and operated a Epilight for many years and know the difference between the two. The big difference between the two is that the Starlux has both a high and low filter (Epilight only had a low filter) and that the Starlux filter is a more accurate filter. But the inherent limitations are the same.

Let’s look at the study first. This study was of only ten people and two treatments. The problem is that the effectiveness of all lasers is really statistically equivalent in the first few treatments. It is only after multiple treatments over time that one sees real differences. Plus, ten people is not enough to see a statistical difference unless that difference is humongous.

But to go back to the issue of multiple treatments. One of the arms of this study was a diode laser. I was one of the first persons in the US to use the Palomar diode when it came out. We kept that diode for five years and during that time it broke down twice. And we did millions of pulses on that diode. Yet, we now own no diodes because we came to realize over time that the diode had an inherent limitation that made it an inferior laser to the alexandrite and the YAG, even though my alexandrites break down about once a quarter and cost thousands of dollars more to repair over their lifetime. And there are studies that confirm the very difference between an alexandrite and diode laser in effectiveness, yet this study found no difference. Why? Because it was not robust enough to find a difference when it exists. In other words, it would be called a false negative, it found no difference when one existed. And the same is true for the IPL arm of the study.

As far as the gentleman’s experience; 237 clients in a year is not a significant amount of experience. We treat that many clients in a day.

The problem with these kinds of promotions is that they are always from people who own the machine less than a year. The reality is that it takes 1-3 years for the problems in a technology to manifest itself. I am still waiting for the person who has used IPLs to build a vibrant busy business and has been using them for five years to speak up and talk about how good their results are. The reality is that every business I know about that has focused on using IPLs as their primary hair removal device has gone out of business.

The bottom line being that IPLs can provide good results. But that a large spot Alexandrite still provides better results over the long run.

4

Mr. Medspa Owner/ Starlux Operator,

I found your post both invigorating and refreshing. You touch on something that, as a former science researcher, I find frustratingly overlooked here in this forum. It’s something that’s overlooked because there seems to be a gap in the actual knowledge of laser - hair interactions by many in the laser field, with both, operators and clients.

IPL is the future of light-based hair removal, not the alexandrite, not the diode. Why? More so because it is not a true laser. That is its strength. Anyone with any background in spectrophotometry knows about absorption spectra. Anyone with any background in lasers knows about the absorptive specificity of single wavelength light, anyone with any background in the nature of hair knows that there are vast shades of hair in the human genome, and even one hair strand can change color as it approaches the hair’s papilla, it can get darker, lighter, or even transparent. Color is absorptive index, it’s not just a dark and light thing. This indicates that for a photon emission source to be effective, it can’t bank on hammering energy into such a specific wavelengths as 810nm or 755nm. This is an outdated approach the ‘true laser’ manufacturers have already taken to it’s limit. Alexandrites and diodes won’t become much better than they are right now.

On the other hand, IPL has always correctly banked on the concept of broad spectra, but the R&D just lagged awhile to get the intensities in a good range. And, although perfecting the IPL process is a lot more expensive than that of traditional laser technology, the assisting technologies that IPL is dependent on are coming of age, whether it be photon pumping sources or controlling heat dissipation. It has been brought up that IPL clients deal with diminishing returns, but there is no way at the improved fluence levels with such a broad hit range, the older mono-wavelength tools will compete, and will much earlier exhaust their effectiveness as hair roots lighten in early catagen phase, not even yielding a shot at partial upper bulge/ sebaceous gland destruction. Sure, they’ll blast the client with painful amounts of heat, stunning hair growth for a bit, but in the end are impractically attempting to extend the usefulness of their units. Blunt force won’t cut it. Some of the best, most successful light-based hair removal clinics here in San Diego already realize this, cranking up IPL systems instead of selling out to the standard Candela products. I’m watching this play out and it’s going to be interesting to see how it effects regulations.

As time goes on, and the IPL proves itself as more applicable to a wider spectrum of clientele hair types, I think it will dominate as the industry standard. As this happens, and the pain-light source intensity/ effectiveness ratio decreases, and the safety factor increases, I think The AEA should make it’s move to lobby for extended training in AEA accredited schools to teach use of new IPL technologies within a cross-trained electrology/light based non-MD setting. The AEA has to make it evident that two years of experience with skin and intensive training in operation at least equals what an operator would learn in a weekend laser ‘workshop’. You know, kind of comparing it to the amount of training a paramedic receives, or a police officer receives, and these people deal with people bleeding to death. Somehow they have to get operational privileges of these next generation IPL units to stay competitive and independent. These may be the most promising initial hair clearing tools.

Thanks for forwarding your post to Andrea Mr. Medspa guy, it’s very refreshing to hear from the field experience with the various machines coming out. I am a loyal follower of the electrology process, 125 years of proven success speaks for itself, but I think you are onto something good. And keep us posted with studies like that out of Mount Sinai Med School, that’s a good one! That’s what everyone here needs to keep up on, factual accredited institution studies.

Mantaray

5

I’m sorry, but reading your comment, such as your quote, I’m not sure what you are talking about. And I would like to think that I am not particularily stupid.

What I think you are trying to say, is that IPL is better because it can be tailored to the hair. Which sounds like a good thing, but actually is impractical in reality.

First, some facts. IPL research is actually pretty cheap. One of the reasons that so many companies sell IPLs is that they are cheap to make and the profit margins are much bigger. For example, it costs about $40K or so to make a laser which is sold at about $70-$80K. The difference between the cost to make it and selling is used for marketing, overhead, and profit. It costs about $20K to make an IPL but they also sell at about $70-80K. The reason they are so much less expensive is that the first stage in making a laser is basically an IPL. So an IPL just skips the laser part and just puts out a broad spectrum of light.

Second, IPLs light is incoherent. In other words, the photons travel in all directions. Laser light is coherent, or in other words, the photons are all traveling in the same direction much like soldiers in a parade. One of the most important thing is depth of effective penetration which is why the larger the spot size the better the depth of penetration. But this is based on the light being coherent. When the light is not coherent, then scatter is increased and effective penetration is decreased. IPLs try to overcome this by using crystals to help focus the light, but they can’t make the light coherent. Ultimately, this does put a limit on IPL photonic energy.

Third, the reason so many people buy IPLs is because they can be used for many different things to include photofacials and vascular lesions. So why buy three devices when you can just buy one? And they are actually the gold standard for photofacials.

So now back to trying to tailor the light to the hair color so as to be more effective. One problem with this issue is knowing what color the hair is. Given that it is sort of impossible to know what the actual gradations in hair color are at the root, it makes kind of difficult to figure out how to tailor the light output of an IPL to match.

But there is a more difficult problem and that has to do with the total energy absorpotion. Let’s compare 25 joules on an alexandrite to 35 joules on an IPL (that filters from 650 to 1100 nanometers). First, the fact that the joules are higher says something about the total absorption. But focusing on the energy absorption, it doesn’t really matter whether the hair is black or brown, it will absorb the same relative amount of energy. I don’t say the same amount but the same relative amount.

Now here is the problem. Even though the amount of energy is higher, at least half of the photonic energy is going to be in the higher wavelengths, where it is less absorbed (regardless of color). The net result is that one has to increase the power to over come this absorption differential. And the best example of this is to look at the effect on skin rather than hair. An IPL at 25 joules has little effect on skin whereas an alexandrite at that setting will burn a skin type III and above. Why? Because the skin, which is composed of different shades, will absorb more energy from the same power beam from the alexandrite compared to an IPL. Now crank up the power on the IPL and you eventually get the same amount of skin burning. The point of all this being that absorption between the two is really equivalent.

But because the IPL is not coherent, the effect at depth is decreased. And this is why IPLs tend to be less effective in the long run from lasers.

Finally, the argument that one can tailor an IPL to the hair color and thereby treat a larger spectrum of hair colors (to include blond hair) has been around since the very first IPL. ESC use to make this claim until they got sued by practitioners who were unhappy because it couldn’t actually treat blond hair.

On a personal level, I would prefer that more of my competitors would use IPLs rather than lasers. Unfortunately, on the other hand, I don’t want their customers to come away with the idea that the results they get is as good as it can be.

6

I was wondering how other practitioners felt, if they too preferred their competitors use equipment that was inferior?

Regarding the electrologists who post here, I never got the idea that they hoped for such a thing. In fact, even though we disagree on some issues, we spend a great deal of time trying to inspire our colleagues to purchase better equipment.

Interesting.

7

I agree with you Arlene. Though this does not relate to sslhr’s post, it appears that a lot of electrologists do not update because they are happy in their comfort zone and re-learning how a new epilator works can be nerve racking and intimidating, as there is no instructor standing next to them giving them a tutorial. It’s seat of the pants time for most,unless they can tap into a colleague’s experience who has the same epilator. Somehow relying on the principles of hair destruction just doesn’t always compensate for learning how these newer tools work, but once you ‘get it’, you will never look back at your old epilator the same way. A top of the line epilator is expensive, as well. No, we don’t hope for other electrologists to offer inferior services and equipment because that makes all of us look inferior as a profession.

IPL’s are cheaper than the quality LASER’s available. What I don’t know is this: Are they easier to operate than a true LASER?

8

I rest assured that the tongue was firmly in cheek, eyebrow raised, and smirk in place on that comment.

“The Pinky and The Brain” in all of us would love to have that super advantage over everyone else, and have the world beat a path to our door. The realistic side of us knows that if what is easily available across the country is something OTHER than what we provide, and that something is inferior to what we can and do deliver, it makes any claim we make seem to be incredible… as in the original sense of the word – with no credibility.

And that is exactly why we get into it here about the equipment issue. Although I don’t have to argue to people that one can get better, faster service at a mechanic’s shop if the auto repair guy has a lift, air tools, and computerized diagnostic tools instead of a hand jack, breaker-bars and manual wrenches, a large segment doesn’t seem to see that the same idea carries over to electrolysis.

It is true that a person who doesn’t know how to use any tool can’t possibly do the best work possible, and it is also true that the more knowledgeable a practitioner may be, the more that practitioner can get out of better tools, once that practitioner understands the operation of the same.

I wonder what Leonardo would have done with an apple computer and holographic image capabilities instead of paint, canvas and charcoal.

9

haha. this is exactly what sslhr said, alas with a bit of humor :slight_smile:

10

I was trying to use a little tongue in cheek at the end of my reply.

The truth is that I have a lot of money invested in my business and I have 80 employees who seem to want to be paid on a regular basis, so I do have a desire to be competitive. And at the end of the day I want to be successful and the best at what we do. So if I was a rotten dirty low down scoundrel I would be telling everyone how good IPLs were and that everyone should treat with the Syneron IPL 'cause it can treat all hair colors. All this while I personally use alexandrites and YAGs.

But I also consider this my chosen industry (laser hair removal) and I want to be proud of this industry. I don’t want the industry to have a reputation of everyone just being out to fleece the public with poor quality and hard sell tactics. Which is why I occasionally comment about the different systems and what I think about each one. Having owned every type of technology and being able to buy what I want, I feel qualified to comment.

And by the way, the comment by dfahey which lagirl quoted ultimately said it better than I ever have.

11

I’m the one who originally posted my comments plus the survey. I’ve read through the comments both pro and con. I too have been using lasers albeit not in this specific manner for many years. I did not post the study to do anything other then to dispel the myth specifically for the Palomar Starlux, that IPL’s are inferior to Lasers for hair removal. That was indeed true 5 or so years ago but it’s not the case today at least for Palomar. I can’t speak for other IPL’s except to say that I tried each of them as well as Lasers in my 9 month search for the best platform. As a former “C” level exec I was able to see not only what exists today, but also what was coming out in the not to distant future. Rather than argue about what’s best and who does the most treatments I can only state that we’ve treated dozens of patients who had not achieved 80% clearance on a laser and brought them to 90% plus with the Starlux. Rather than go into the technology behind why it works vs. a true laser (which the Starlux also is with YAG plus 1540 Fraxel) or try getting into a duel of my knowledge vs. anyone else’s I’ll let you all debate that. I’ll just post verifiable medical evidence as this industy is rife with claims and low on results. Many doctors are paid shills for Laser companies who in turn use those claims to boost sales. I’m a business man who took his time evaluating products to seperate hype from truth to launch a successful new business. I consider myself a student for life as this industry is all about new innovations which I will stay on top of.

12

Just to reply to your shot at haveing only done 237 laser hair patients. Laser hair is just 20% of our business as we specialize in far more advanced procedures and have treated thousands of patients. Check out the cover story of Florida Trend Magazine for December if you want more details on why we’ve been recognized as one of the top MedSpa’s in the state and one reason why Johnson & Johnson used us as one of their 4 beta test sites in the country to trial their new TruVu system.

13

It wasn’t a shot at only having done 237 clients, it was a comment that that is a very small sample size. It may sound like a lot compared to the 10 or so who are in a treatment arm of study, but it really isn’t very many people.

The other problem is that it turns out that the wall (and there is a wall) occurs at about 2-3 years in a practice. This is when the clients who have had 8 or 9 treatments and are having poor results begin to get upset. Up until that time, everything is hunky dory and then all of a sudden you start to get clients who are upset. Ones who were having “good” results but now all of a sudden aren’t getting there or seem to have plateaud and still have quite a bit of hair. You’re not there yet. This has been the point when most laser hair removal operations either go out of business or suddenly find themselves emphasizing other parts of their operations. This has been my experience watching hundreds of operations through out the country over the last 9 years. Even big operations like Sona hit that wall (they are in lawsuits now) and Ideal Image is starting to get there.

Good luck, you are a year or so away.

14

When the client starts complaining at the 2-3 year mark, what happens after this? Will more LASER treatments help or do you recommend electrolysis to finish the job? I would assume that you could explain to the client that this event may come in that first consultation and perhaps the client would not be so upset when they have reached what is described as “diminishing returns”. At least they were told this information up front.

Dee

15

sslhr,

OK and since I’m not post 2-3 years I cannot offer any insight. That said however if you treat the public not only as a patient but as a client and underpromise and over deliver any business will succeed. In just the past 3 years of building, opening and finally running a MedSpa the number of clinics and practitioners making bogus claims is staggering. We’ve lost many clients when we simply educate them on the truth of how lasers operate and that they should expect an 80% reduction vs. 100% laser hair removal promised and seldom if ever delivered by other places. Just last evening one client came in after having spent $4,000 over the past 2 years on her legs which she believes is 90% free of hair. When I told her electrolysis was now her only option she thanked us for not taking any more of her money like others were doing. Anyway it sounds like you have built a very successful practice so congratulations and I hope to achieve a similar track record 3 years from now. We have an incredible staff that loves to help people achieve there non surgical cosmetic goals. Technology is great and one should always strive to supply the buying public with the best in class. That said however without best in class staff the results will never be good enough…

16

A lot depends on the reason that they are aren’t responding and the reason that they are complaining. If they aren’t responding because the laser that is used is incapable of treating them any further (an example would be a diode with fine hair). Then more treatments won’t help. On the other hand, if one is using a laser that can be effective, then the solution is to figure out why they aren’t responding and take the steps necessary to change that. Many people won’t have good results in the beginning for a variety of reasons, but can get to excellent results with the right approach. But it is not always easy.

17

Sounds to me like you are doing the right thing for your staff and clients. Which I think is really the most important thing to do. And gets you on the right track toward success. Good luck.