With non-invasive body contouring treatments booming, leading experts reveal what you should consider and clinicians explain how they found their perfect system
In aesthetic medicine, fat has long been seen as ‘liquid gold’ because of the way demand for body contouring, fat reduction and anti-cellulite treatments can add value to a practice. Certainly they have never been in greater demand. According to a survey conducted by BAAPS, surgical body-shaping procedures such as liposuction and tummy tucks were down 14% in 2012, which Rajiv Grover, consultant plastic surgeon and President of BAAPS, says may well be due to the increasingly effective nature of non-surgical treatments. He goes so far as to say that non-invasive methods “will be the future of fat removal”. So should you join the gold rush?
Non-surgical alternatives to liposuction offer many advantages to both patient and clinician. These include faster treatment times, fewer complications, less need for aftercare, no pain and no need for anaesthesia, all of which reduce costs to the clinic and increase the numbers of patients seeking treatment. But in a fast moving market, practitioners must think carefully before making an investment in capital equipment to ensure it is the best t for their clinic, meets their patients’ needs, and offers a good business model.
There is no doubt that your investment could vary wildly depending on the system you choose. Some of the unbranded devices that come from outside the EU start at £8,000 or even less. Basic low level laser devices cost from around £10,000, while other devices using ultrasound and cryolipolysis cost from around £65,000 to over £100,000 and have expensive consumables on top. However, these are backed by big companies and therefore can also offer fantastic marketing materials and clinical research.
To help guide your decision-making, we asked business experts and leading clinicians what their best advice would be for newcomers to the market. Practitioners also explained how and why they made their decision to purchase a particular body contouring system, fat loss or skin tightening system.
Mary-Kay Sheehy, clinical director of aesthetic consultancy business Suite7, has a wide experience in sales, marketing, business development and training in medical aesthetics. She explains that key issues medical practitioners should consider when choosing a system include your patient demographics, clinic size, staff and budget, including the cost of consumables. “You need to look at your patient population, to determine how old and affluent they are, and how committed to treatments they are,” she says. “For example, if you have a youngish, working population they normally don’t have time to commit to three to four treatments a week and would ideally want a one-off treatment.”
Wendy Lewis, president of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy explains why clinic size should be a key consideration. “Space can be an issue, especially in urban clinics. You need to calculate how long the treatment takes to perform and who will be performing it. Clearly the most pro table procedures are delegatable to non-medical staff. Systems that take up a room for hours at a time may make it harder to see good ROI.” She argues that when calculating pro t margins, clinicians must factor in all costs, including the “Capital cost of the device, consumables, the time the treatment takes to perform, as well as staff involvement pre- and post-treatment.”
Tim Stevens, practice support specialist at Coolsculpting, agrees that it is important to know your costs before you invest saying “Companies that are upfront about their consumable costs, and build them into the business plans they present to potential customers, have an active interest in the ongoing training, marketing and success of their clients.”
|5 crucial things to remember when purchasing a system|
Finally, Lewis highlights the importance of not only choosing for your clinic and patient demographic, but also picking a reputable brand. “As a practitioner you should not consider flogging a technology that does not have appropriate clinical data and a CE mark,” she says. “US FDA clearance is also a big selling point for consumers today.” Although she explains that it can cost between $10million and $75million to obtain, and can take ve or more years. Mary Kay Sheehy agrees, adding “FDA approval would be ideal but it is a long process and sometimes it costs too much for companies to get it.”
However, Lewis warns, “Cheap no name devices with zero consumer awareness or clinical data to support their claims are not the way to go. Consumers today are savvy and go online to find out what the best devices are and who has them.”
Dr Raj Acquilla, cosmetic dermatologist at the Dr Raj Acquilla Clinic, says that although investing in more well-known fat loss technologies can be expensive, prices have come down. “Anything good used to cost between £80,000-£100,000,” he says. “Now you can get a really high quality device for £30,000 or £40,000. They’re not far beyond the reach of an introductory to intermediate budget.”
Lewis details the structure you should put in place surrounding your investment, saying “For every new treatment you offer, you should have a marketing plan, pricing strategy and necessary assets in terms of materials, brochures, posters, before and after photos and web pages in order to launch it properly and make the most of your investment.”
Dr Claire Oliver, owner and clinical director at Air Aesthetics Clinic agrees marketing is vital: “Be mindful that large investments in technologies require a commitment to marketing to ensure targeted payback of system is achieved.”
Dr Ravi Jain, medical director and founder at Riverbanks Clinic, says market research is an easy way to both determine what your patients want and to begin marketing to them. “Simply send your client database an email telling them that you are thinking of investing in systems a or b, and asking them if they would be interested in this. If they are, you know they are potential patients; they are already intrigued, you won’t need to do too much marketing and you can make a profit quite quickly.”
When buying a system Sheehy suggests opting for one that offers continuing training. “It is only after many treatments have been performed that manufacturers learn how to make their protocols even better. With many of the non-invasive body contouring devices the techniques are vital to getting the right results, and a one-off training session is normally not enough.”
Effectiveness and safety must be prime concerns for any clinician wanting happy patients. Dr Nick Lowe, renowned consultant dermatologist at The Cranley Clinic, says, “Before making a decision about any technology, always ask about the research.” He opted for cryolipolysis system CoolSculpting by Zeltiq, “Because of the reputation of the scientists at Harvard MIT who developed it. I went for it because of the volume of peer reviewed research that was conducted into its safety and efficacy,” he says. Dr Tracy Mountford, founder and medical director of the Cosmetic Skin Clinic, also opted for CoolSculpting primarily on its scientific merit, but also because it met her other core requirements.
“I spent a long time looking for an alternative to liposuction, because I wanted to stay pure to my business model which is to offer purely non-surgical treatments. My patients were asking my advice about treatments that were already out there so I knew there was growing demand, but to meet their needs, anything I offered had to be safe, proven, painless and have no downtime.” Similarly, cosmetic dermatologist Dr Raj Acquilla, who uses radiofrequency device Exilis from BTL in his clinic, agrees that evidence is crucial. “You have to go on the evidence,” he says. “I didn’t consider any system unless it already had FDA clearance, and it had several exhaustive critical papers behind it with good medical research.”
Patients today lead increasingly busy lives and want faster, one- off treatments with no downtime.
Dr Ravi Jain uses ultrasound system MedContour and cryoliposis system CoolTech in his clinic. He says he was impressed by the technology of cryolipolysis, and chose CoolTech primarily because he believes the results can be more aesthetically pleasing than with other cryolipolysis systems, but also because of the speed of treatment. “Because the system includes two headpieces, you could treat two areas in one hour,” he says. “So the treatments were quicker, and it was much more cost-effective with a faster return on investment.”
To meet the growing demand of patients for faster, one-off treatments, Dr Tracy Mountford, who has created a dedicated CoolSculpting suite at her clinic, has recently invested in a second CoolSculpting device in order to offer patients ‘DualSculpting’ in which two areas are treated at the same time, halving treatment time and increasing the number of patients who can be treated in a day. Dr Jain explains why investment in a machine that works well for your clinic and patients is so important, “MedContour has an inexpensive initial outlay, and isn’t very practitioner dependent so new therapists could still get good results from it. However, patients had to come every week: many wouldn’t travel long distances, so we lost a lot of enquiries and only had local patients.” Dr Acquilla adds that if a system does involve diet, exercise or multiple treatments then, “The shorter the duration between treatment intervals the better, because the patient’s compliance levels are greater then.”
Dr Carolyn Berry, clinical director at Firvale Clinic who uses CoolSculpting, says “Fat is big business, but my patients don’t want to take time off work to recover. They also want minimal pain.” Dr Lowe says he rejected certain ultrasound treatments because although effective, they were, “Horrendously painful”, which might discourage patients from a return visit.
When considering adding body contouring to your clinic, you may wish to consider how it complements your existing treatment offer. Both Dr Tracy Mountford and Dr Lowe say CoolSculpting works well with their existing Thermage radio frequency skin tightening systems from Solta Medical to tighten any small areas of loose skin. Dr Sach Mohan, founder at Revere Clinic, invested in radiofrequency body contouring product EndyMed by AesthetiCare, which he uses in combination with CoolSculpting.
“I chose EndyMed because of the way it harnesses radio frequency technology and has multiple radio frequency generators, which repel against each other, driving radio frequency deeper and helping us achieve uniform tissue-heating, which is the clinical endpoint,” he says. “EndyMed and CoolSculpting complement each other well because after eight out of ten CoolSculpting treatments, patients will have some loose skin,” he continues. “You can lose one and half litres of fat from the treatment, so we can use EndyMed to get very good skin tightening afterwards.” Mohan also says versatility was important to him. “Endymed has multiple modalities and indications,” he says, “Including a facial handpiece and a fractionated resurfacing handpiece (FSR) which is able to both resurface and tighten the skin.
This enables us to treat stretchmarks often seen in conjunction with the subcutaneous elastosis.” If your core business is in facial aesthetics, it could be useful to choose a system which can treat the body and face. Dr Acquilla says, “I use the same modalities with Exilis for chin and jawline reshaping as for lower limb rejuvenation. I need to select a device that has the accuracy and flexibility to deliver energy to those very sensitive anatomical areas, and Exilis has a body piece and a handpiece.”
For those who are considering a particular system but are still uncertain, Dr Ravi
Jain suggests taking your time to really consider the various options. “Attend meetings,” he says, “ Speak to people who have systems, and attend workshops where machines are demoed, where you can also speak to other practitioners.” Donnamarie McBride, director at LoveLite Ltd. also suggests that practitioners do their research. “Research is the key,” she says. “Speak to other people who have the machine, even if they’re in a different country. It’s also important to try the machine out yourself.” Speaking to other practitioners who have the system that you know rather than going through the sales representative or company is key as they may pick practitioners who may not give you an accurate picture. It may be beneficial, therefore, to talk to clinics outside your area, including in Europe or ones based in the US.
Wendy Lewis agrees that you should trial a machine before buying. “Try a device on a few of your own patients or sta before you buy, to be sure it is a good t for your clinic,” she says.
Esther Fieldgrass, founder of EF Medispa, who uses Accent Radiofrequency by Alma Lasers in combination with Multisculpt, a combination of radiofrequency, infra-red and mechanical massage, says, “I attend conferences where I try the equipment myself; I need to know that what I’m offering my clients I would have myself, and that it’s going to work.”
Dr Acquilla trials potential systems on willing patients: “I wouldn’t make a commitment unless you know whether it’ll work in your practice. I’d suggest a two to three month loan period from the manufacturer before buying. You may need to pay a deposit, but that is a worthwhile investment.”
Dr Jain states, “Every practice should be in body contouring because that’s the biggest growth area in aesthetics.”
As our experts have demonstrated, by researching your options thoroughly and considering key factors such as your demographic, clinic size, budget and treatment menu you can find a system that works for you, your business and, most importantly, your patients.
It is a risk to choose to buy from unknown manufacturers, particularly if bought online from outside the EU. In a worst-case scenario, these can injure patients. This may damage your reputation if patients complain or sue, and may even ruin your career.
“There are plenty of rebadged Chinese and Korean exports online that put a lot of money into marketing to make them look legitimate, but they have no good regulatory standards. They fall apart, have no warranty and no feedback mechanism.” Dr Ravi Jain
“I am concerned that with some copycat cryolipolysis devices there is a real risk of causing ischaemic freezing ulcers.” Dr Nick Lowe
“You have no guarantee of knowing what you are buying: it could just be a fancy computer on the outside, but the insides are useless. You have no guarantee that it will do what it says, of who will x it if it breaks and how much that will cost. It could cost you a lot more in the long-run.” Mary-Kay Sheehy
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