PracticalDermatology

With the coming addition of my son, Daniel, to my practice, something that I have dreamed about since he was a very small boy, it became appropriate to add some new equipment to my previous solo dermatology practice of 31 years. Although we had continued to purchase new lasers and perform new procedures, there are some that I was on the fence about until I knew whether there was a blue-sky horizon for the practice.

This culminated on December 31st, resulting in a last-minute flurry of phone calls, emails, and texts, which supplemented the previous month of in-person meetings with various laser companies. Many of these companies are ones I have been in touch with over the past five to 30 years for initial purchases or evaluations of products. Despite having purchased over 30 lasers (I really lost count years ago), this recent experience was illuminating. 

As a spoiler alert, Daniel and I ended up purchasing a Sciton mJoule and JouleX for the practice, but not without a great deal of education, discussion, and trepidation. These new lasers are eye-popping in their costs, but also have a wider array of options and treatable conditions, at least for the ones we were looking at this time. 

From the standpoint of “teachable moments,” the most important thing I can say is that I learned (the hard way) that Section 179 tax deductions only apply for those pieces of equipment that are not only purchased, but also in service by end of year. To me, this means that in the future (and for anyone looking to have their laser and take the deduction for the current year), negotiations should start much earlier in the year-end cycle. My guess is that I would have needed to start discussions around early November to make sure the laser was delivered and paid for by December 31st. Unfortunately, if you want to get the absolute best deal, you ought to focus your negotiation efforts on the last 10 minutes before the ball drops (or even after you ring in the New Year, depending on the time zone for your laser representative).

One other aspect that I can’t overstate is the importance of having a network of people who have the laser who you can lean on for advice during the process. Our sales representatives were extremely professional, but it was a huge help to lean on friends like Michael Gold, Suneel Chilukuri, Joel Cohen, and H.L. Greenberg for advice in the process. Even with an advanced usage of lasers over the years and many experiences at the Sciton booth prior to purchasing it, I still needed their advice on what was useful, what was not, pricing strategies and simply an ear to lean on when I had challenges. This has continued to be a source of strength as we have been in-serviced and are now seeing patients and exploring the limits of the equipment. 

New to this purchase is the focus on disposables and the change in approach by the laser companies. Starting with my first laser purchase in 1994, I had a varying level of professionalism by laser companies, some of whom were extraordinary and some who reminded me of a used-car lot experience. While I can’t say that this doesn’t exist at the present time, I was truly impressed. Part of the reason that the focus doesn’t have to be on the initial price is the continued dependence on disposables, however painful that is over time. Despite that ongoing need to purchase these, I am hopeful that it will allow a continued focus on research and development by the companies and a more “long-term” relationship.

However, these disposables also can be part of the negotiation process, and you may find that your laser rep has disposable “trunk stock” that they can throw in along with the purchase to sweeten the deal. Do your research on any other add-ons or upgrade parts, smoke evacuators, coolers, or goggles as these are also parts that could be added on during the negotiation process.

Lastly, I have to commend Sciton in particular for the educational opportunities they have created around their devices. Their programming—both in person and virtual—is so much more thorough than for any other devices I have ever had. This may, of course, be since many of these will end up in the hands of extenders and non-dermatologists, but all the same, I was amazed at the abundance of articles, short-form videos, full-length recorded seminars, and live educational sessions for the suite of lasers we purchased. Additionally, onsite training was impressive and aimed at the entire group of my staff, as opposed to other trainings that were brief and perfunctory. 

It is exciting to start this new chapter with my son and I will be learning quite a bit from him as we move forward. I plan to share those and other aspects of this with my readers over future issues.