The newest “must-have” category of skin care products in stores and on television is the at-home device. With built-in cost-savings and convenience, at-home devices present dermatologists with potential new competition. Despite the inherent challenges to our professional treatment offerings, many of these devices have proven to be beneficial for patients. Recent advancements have brought more variety and better efficacy to hand-held devices. Thus, the question remains: Are these technologies good or bad for dermatologists and the general populace?

Ahead, I will share some of my experience with these devices and distill some insights as to their general use in a broader cosmetic dermatology setting.

First-Hand Experience

When I first was exposed to home laser devices and the concept of home laser hair removal, my thoughts were anything other than charitable toward the new technology. I felt the devices would siphon away patients from the expensive lasers we had purchased over time and degrade the excitement about what these offered our patients. Over time, however, I have come to a slightly different conclusion, in part due to where our practices are moving. We see competition from a number of sources, including medispas, Ob-Gyn practices, family doctors with a laser or two, and these home-oriented devices sold over the Internet or in stores, such as Nordstrom. Our ability to integrate the new technologies into our practices allows us to, at the very least, compete with the other options available and potentially win out, since we have the patient in our office and the devices in stock.

In my practice, we incorporate various devices such as Clarisonic, TRIA, and Me Smooth hair removal laser/IPL and, most recently, Tanda red and blue light devices into our offerings. We have had one home laser as well, but the acceptance on that was very slow compared to the brands mentioned above. This may change as newer and more robust options in home laser are introduced to the market.

In general, my patients appreciate the options we offer and have embraced the concept of beginning with a more robust experience with hair removal via one of our in-office devices before transitioning to the at-home laser for hair “stragglers.” Generally, this has made our approach to laser hair removal cost-effective when compared to the patient’s experience with the medispas in town, which must retain all patients on “plans” in order to make a profit. Additionally, our patients recognize that we are not focused on the bottom line as much as getting them to a better place in their hair removal regimen.

When it comes to larger areas of hair removal, such as legs or backs, the at-home devices don’t come close to the efficiencies of in-office lasers, so these patients can be retained easily. As for the lips and underarms, we still have many patients who prefer the in-office experience but use the at-home devices occasionally and are re-assured they are hair-free between office visits.

Other tools, such as those manufactured by Clarisonic, can provide benefit for acne patients with comedonal acne and those who wish to have a more effective method of cleansing. Generally, we introduce these technologies via our estheticians, who will often start the experience with a Pelleve treatment, facial, or SilkPeel, and then transition to an at-home device. This provides a constant reminder for our patients as to where their care originated.

When it comes to blue and red light devices, I haven’t been quite as impressed with the sales potential of this category, but that doesn’t mean that this area won’t grow in the future. I have many acne patients who refuse or aren’t able to tolerate antibiotics. In particular, one patient with Crohn’s disease has seen significant benefits from the blue light treatments. This also represents a way to reach out to those patients looking for a more natural approach to their treatments. Rather than taking away from our offerings, it supplements them.

The perception of where these tools fit into our practice depends on the types of tools that are provided to us and how we promote them. Additionally, it’s important to take into account the benefits and efficacy of these tools. Some devices may be no more than an elegant light, whereas others clearly provide benefits that we can’t provide as cost-effectively. It is incumbent upon the physician to determine these benefits if they are not readily available; one infomercial hair removal device that does nothing more than singe the hair.

From my standpoint, the rationale for considering any of the newer devices for any practice falls somewhere between customer service and a competition imperative when you consider where your patients will access and purchase these devices. It’s better that they access the technologies in your practice than purchasing them on the Internet or at the mall. To encourage the patient’s acceptance of our help, it’s important to provide a range of devices at reasonable prices, and even include some extras such as accessories or low-cost facials with some purchases. This is something that many dermatology practices can and should consider in order to gain the trust and confidence of the patients while closing the sale.

Notable Hand-held and At-home Devices

• The Clarisonic Skin Cleansing System removes six times more makeup and two times more dirt and oil than manual cleansing and retails for $195.
• The Clarisonic Opal Sonic Infusion System is used for the eye area and can also be used on the lip, brow, and forehead areas. It retails for $185.
• The PaloVia Skin Renewing Laser is a 1410nm diode laser, which uses 15 MJ and 250 micron coagulation. It is the first FDA-cleared, at-home laser clinically proven to reduce fine lines and wrinkles around the eyes. It retails for $499. A potential competitor to the PaloVia, the Phillips 8-9 is not yet available; others are on the horizon.
• Baby Quasar Light Therapy is presumably effective to fight signs of aging, damage, firmness, color, enlarged pores, and wrinkles. Its red light treats anti-aging ($399), whereas the blue light treats acne ($299).
• Tanda Luxe Anti-Aging Light Therapy Treatment uses red LED light to boost overall cellular energy, increasing the production of collagen and elastin and increasing microcirculation. It retails for $195.
• Tanda ZAP Anti-Acne device combines blue light treatment with sonic vibration and warming to treat acne. It retails for $49.
• The Claro IPL Acne Clearing Device uses heat and light to treat mild to moderate acne and retails for $195.
• The Zeno Acne Clearing device is used to treat mild to moderate individual acne pimples and retails for $129.
• Syneron Me Smooth uses IPL and RF to treat all skin types and is approved for body treatments. It retails for $395.
• The TRIA 4 At Home Laser uses 810nm diode laser light to treat skin types I-IV and is approved for face and body usage. It retails for $449.

Conclusion

The general approach I’ve described here seems to work in my practice and could serve as a potential model for looking upon at-home and hand-held devices as useful rather than detrimental to any practice. Additionally, the numbers and types of tools available will likely expand, and therefore having a familiarity and base of understanding should certainly be a benefit for the practicing dermatologist.

Dr. Schlessinger has disclosed that he sells Clarisonic, PaloVia, Quasar, Tanda, TRIA, and Me Smooth.

Joel Schlessinger, MD is Founder and Course Director of Cosmetic Surgery Forum. He practices in Omaha, NE. The 2013 Cosmetic Surgery Forum will be held from December 5th to the 7th in Las Vegas, NV. For more information and to register, visit www.CosmeticSurgeryForum.com. Contact Dr. Schlessinger at JS@CosmeticSurgeryForum.com.