PracticalDermatology

In busy aesthetic practices, where there is continuous patient flow, a robust budget for equipment is practically a necessity. Equipment for an aesthetic practice can range from pricey laser or light devices to an electronic medical record system to cameras for clinical photography. Ahead, I share pearls for maximizing your investments in the aesthetic equipment spectrum, from relatively minor purchases for those starting out, to long-term commitments.

JUST STARTING: An In-Clinic Camera

Aesthetic procedures—arguably more so than medical procedures—demand a visual component for an optimum treatment experience for patients. Whether it is to establish realistic expectations with before and after photos demonstrating results that can be attained from the procedure suggested, to showing post-treatment improvement, a good camera is integral for physicians who perform a significant amount of cosmetic procedures. Photographs also serve as documentation or evidence if doubt arises that a procedure caused something that was already present and previously went unnoticed by the patient prior to the procedure.

In my practice, I use the Canon EOS Rebel T5i Digital SLR with 18-135mm STM Lens. Listed at $899, this camera is a good starter clinic camera for both advanced amateur and beginning professional shooters. For example, it has a detachable lens that fits on an independent body and it also allows for different settings for all types of subjects. Arguably its best feature is the manual setting, which allows the shooter full control over the exposure and lighting.

It is important to note that simply having and using a good camera in practice does not guarantee success or return on investment. The clinic camera, after all, is only as good as the photographer. Lighting, exposure, composition, and consistency are all hugely important aspects to taking and using good clinical photographs. While there is always an adjustment period to any new piece of equipment, one way of expediting this process and ensuring optimum use of a camera is to take a class, or have staff members operating the camera, to be educated on basic camera knowledge.

PUT A RING ON IT: Medical Devices

Given the relatively high expense of medical devices, selecting a premium device that’s ideally suited to meet your clinical needs and the demands of your patient population is key. There is no one device that will address all or even most of the aesthetic needs of your patients. That is why you must be discerning in your decision-making and consider the practical as well as clinical benefits of each device. Here, I will share pearls regarding the value of the devices I am currently using in practice.

ThermiTight. One of the newest additions to the minimally invasive ‘skin tightening’ device arena is the ThermiTight by ThermiAesthetics. It employs temperature controlled RF via a fiber that is inserted subcutaneously to heat the dermal-hypodermal interface, bypassing the epidermis altogether. The system delivers MRF energy directly into the subdermal tissue through a 600-μm electrode enclosed in a 1mm cannula and extending 1-2mm beyond the distal end of the cannula. The internal temperature can be set to 60-70 Celcius (optimal temperature to achieve collagen denaturating), and an internal temperature monitor automatically turns off the system if the internal temperature exceeds the set temperature by 7 degrees Celsius.  Simultaneously a forward looking infrared camera (FLIR) (FLIR E40, FLIR Systems, Inc.) allows for radiometric IR-video streaming with thermal monitoring of the entire epidermis in the treatment field rather than a single spot.

In our practice ThermiTight has proven useful to tighten lax skin of the arms, medial thighs, and abdomen in patients who are not ready or willing to undergo the morbidity, mortality, or scars that accompany a brachioplasty, thigh lift, or abdominoplasty. As the probe runs through the subcutaneous plane, and in-vitro.

Lumenis M22 IPL. General skin rejuvenation is a common request from patients, and with the M22 IPL the treatment of dyschromia from chronic sun exposure, lentigines, and melasma, as well as erythema and telengiectasias, can be improved in just a single treatment. Among the features of the M22 IPL are cut-off filters (instead of having to change the entire hand-piece), a sapphire cool light guide for contact cooling of the epidermis, optimized pulsed technology for homogeneous energy delivery over the duration of the entire pulse, and multiple sequential pulsing, which allows for skin cooling between pulses without sacrificing efficacy.

In addition to performing photofacials, one can utilize the M22 to activate ALA in photodynamic therapy for the treatment of actinic keratoses, acne vulgaris, rosacea and photorejuvenation. The M22 IPL also can treat benign cutaneous vascular lesions and conditions such as spider angiomas, telangiectasias, poikiloderma of Civatte, port wine stains and hemangiomas, leg veins and venous malformations, and erythematous scarring. It can also be used for hair reduction.

From a practice consideration standpoint, it’s worth noting that the M22 IPL is upgradeable, which allows it to treat a wider range of conditions. Among these upgrades is a multi-spot cooled long-pulsed 1064nm Nd:YAG laser for deeper vascular lesions, the ResurFX 1565nm erbium:glass non-ablative fractionated resurfacing laser(more on that later), a QS-1064nm Nd:YAG, and soon a QS-532nm laser.

This device saves on space and time and is easily transportable. These qualities combined with the relatively cost-efficient price (listed at $79,000) make the Lumenis M22 ideal for many practices.

ResurFX. If you want to proverbially “go big or go home,” the new ResurFX upgrade for the M22 offers great upside. Available in a 1565 Erbium:glass module, this device has no consumables and offers a truly fractional one-pass method for non-ablative resurfacing. It has a novel scanner that allows for 600 combinations of shape, spot size, and density for customization, as well as a CoolScan non-sequential scanner plus continuous contact cooling. The lens is located far from the surface, allowing for more consistent focused microbeams, and a full treatment of the face can be achieved within 15 minutes.

In terms of its applications, this device can address wrinkles, striae, and improve texture and tone, as well as improve scars (acne, surgical, traumatic). In my practice I add it on to the IPL treatment, to make it a Photofractional treatment, which allows me to not only treat the underlying redness and brown from photodamage, but heat of the dermis to stimulate new collagen production and improve texture, fine lines and wrinkles.

The ResurFX upgrade module lists at $49,000.

Conclusion

In the end, it is not financially feasible to purchase every device or toy on the market. What works for one practice may not work for another. It is important to consider what is most valuable given the patient population one serves and the business model one has adopted. Whenever deciding what device to purchase, I classically keep in mind what my patient demand is, and what studies the device I am considering has to support its claim of both efficacy and safety to meet that demand. n

Sabrina Fabi, MD is a double board-certified dermatologist and dermatologic cosmetic surgeon. She practices in San Diego, CA.

Article based on Dr. Fabi’s presentation at the 2014 Cosmetic Surgery Forum (www.cosmeticsurgeryforum.com).