A taskforce of cutaneous surgeons in India suggests that performing several common cosmetic procedures, from laser hair removal to fractional laser treatment for aging and acne scarring, is safe in patients currently or recently on isotretinoin. That’s despite widespread recommendations to avoid doing many common cosmetic procedures in these patients, unless the acne drug has been discontinued for at least six months.

The concern for more than two decades has been that isotretinoin (13-cis-retinoic acid), a retinol derivative of vitamin A commonly used to treat severe acne vulgaris, has pharmacological actions that affect epidermis, sebaceous gland and collagen formation. This has led to questions about whether isotretinoin use might lead to poor wound healing, keloid development and hypertrophic scarring after common cosmetic and dermatologic procedures, according to the review, published online February 2018 in the Journal of Cutaneous and Aesthetic Surgery.

Despite the recommendation to avoid doing many procedures, a number of studies have documented that performing cutaneous procedures in current and former isotretinoin patients is safe.

The Association of Cutaneous Surgeons, made up of clinicians in India, reviewed the literature and, based on their findings, released new guidelines appropriate to brown skin.

They found insufficient evidence to support the current approach to avoid or delay several cosmetic and dermatologic treatments on these patients. The procedures they found to be safe for patients on isotretinoin and those having taken the drug in the last six months include laser hair removal; fractional laser treatment for aging and acne scarring; laser treatment for pigmented skin lesions; fractional radiofrequency microneedling; superficial and medium-depth peels; microdermabrasion; dermaroller; biopsies; radiofrequency ablation; and superficial excisions.

They advise caution, however, when using ablative lasers for full face resurfacing or deep peels.

“The… review shows rather overwhelmingly that the risks of hypertrophic scarring, keloid formation, delayed wound healing and pigmentation are not significant in most dermatological procedures. As such, the recommendation to avoid procedures in these patients was, in our opinion, based on flawed reasoning,” they authors write.

Disclosure: The authors have no significant interest with commercial supporters, according to the paper.

Thomas Jeneby, M.D., a plastic surgeon who practices in San Antonio, Texas, tells The Aesthetic Channel that social media is the cheapest acquisition strategy in his practice.

“At the point of care, I’ll ask how did you hear about me and I’ll get Facebook, word of mouth, radio, online, stuff like that. I don’t do very much traditional media anymore,” says Dr. Jeneby, who presented on the topic in February 2018 at the American Med Spa Association’s AmSpa Show in Las Vegas.

Social media on Facebook, Twitter, LinkedIn, Instagram and Snapchat are a focal part of Dr. Jeneby’s marketing. But each platform requires a different approach, because each social media platform, he says, yields different results.

“It seems like Facebook patients have the most money. They come in and pay quickly. Instagram and Snapchat are… not really ready yet, because a lot of them are young, but when they’re ready, they’re going to come to you,” Dr. Jeneby says. “A lot of my male patients are coming in from LinkedIn. On Twitter, most of my followers… are also men.”

As a result, Dr. Jeneby will hone his posts. He’ll post female plastic surgery videos on LinkedIn from time to time, but, generally, he’ll post something that will attract male social media viewers — a male abdominal sculpting or etching procedure, for example.

“Guys will immediately private message me on LinkedIn and say, hey, I want that,” Dr. Jeneby says.

“Women don’t send private messages on LinkedIn but they do on Facebook,” he says.

Dr. Jeneby says video is king on social media. Static images are going by the wayside, unless cosmetic surgeons offer a discount on a popular procedure, like a $99 Botox treatment, or something free, if — and only if — viewers like, share or comment on the post.

“When you offer something for something, you get more,” he says. “If you’re there just to market, your numbers are going to go down and your impressions are going to go down.”

Getting people on social media platforms, like Facebook, to “viral” your post is a big deal, he says. With new Facebook algorithms limiting posts to show up on a page’s top 25 friends can limit exposure. But if the physician’s practice entices people to comment, like or share, other people on their pages will see the post.

The offer is the hook, he says.

Gain new insights on using social media to enhance your practice marketing at The Aesthetic Show.

NEXT: Social Media Dos and Don’ts

Social Media Dos and Don’ts

Dr. Jeneby, who has been using social media to cultivate practice business for years, says the business owner, or cosmetic physician, and two or three trusted people in the practice have to respond to Facebook and other posts, generally, within minutes.

“After we do a surgical video, I’m always looking throughout the day at the posts,” Dr. Jeneby says.

To make social media work, practices have to engage followers, friends, anyone who responds, quickly. People want to feel important, which is what happens when the doctor or staff respond fast. Dr. Jeneby says he’ll often respond to comments and questions between surgeries or when he has three or four minutes. For similar questions, he’ll copy and paste the answer: “Call me,” along with his phone number and website address.

Responding is necessary even if people ask questions that are in the post. Often they’ll look at the visuals and not read, so they’ll ask a question. It doesn’t matter that it’s right there in the post, answer anyway, Dr. Jeneby says.

Another do: Do social media, a lot. Dr. Jeneby’s practice posts five to seven videos a week on various platforms. Those videos are available on his practice webpage. When he’s doing surgery, someone else holds a “contraption,” which Dr. Jeneby says he made, that allows the person filming to have two phones in each hand. All the while, that person is broadcasting live to Twitter and Facebook from one hand, and Snapchat and Instagram from the other.

Plastic surgeons and others in the cosmetic specialty will get lots of trolls. Dr. Jeneby says don’t ban them from your pages, right away. Let them go on for a little bit, because those trolls and what they write can make “virality” go up — even if it’s negative. Practices should ban the trolls, however, after a few comments in most cases, which means those people will not be able to see the practice’s page, post or comments anymore.

Finally, even though cosmetic physicians pay staff and others to help you with social media activities in the practice, the physician still needs to oversee everything that’s being done.

“Don’t just set it and forget it,” Dr. Jeneby says.

NEXT: Marketing Pros Weigh In

Marketing Pros Weigh In

Ms. OstroffAngela Ostroff, a Manhattan Beach, Calif.-based social media consultant and founder of Bearly Marketing writes in an email to The Aesthetic Channel that social media is a must for cosmetic surgery practices.

“If you don’t engage in a professional social media marketing campaign this will negatively affect your revenue, because you can be guaranteed your competition is doing it,” Ostroff writes.

She recommends that practices start social media campaigns, focusing initially on Facebook, Twitter, Instagram and YouTube. Other platforms can be added later.

“You’ll start will the most popular social media platforms…. These four social media ‘giants’ will work together to drive prospective new clients to your website to learn more about your services and book an appointment. They can also be used to engage and retain an existing client by keeping the conversation going and making them feel connected to your office and services,” Ostroff writes.

Ms. ChiConnie Chi, founder of the branding agency The Chi Group, writes in an email to The Aesthetic Channel that a quick way to gain followers is to run contests, which give away something to the winner.

When it comes to social media success, creating content is valuable. “Before and after photos are always great, success stories are a plus and getting a real client's testimony is golden,” Chi writes.

“Physicians are busy so investing in something like Hootsuite where the content can be automatically posted and scheduled will help keep things moving forward,” Chi writes. “As [cosmetic physicians] build their followers, they can expect brands will reach out to them for co-branding opportunities and an increase in engagement.”

Kevin Tash, president and CEO of Tack Media, writes that one bullet-proof tip for a successful social media campaign is to use consistent hashtags.

“… grab 12 to 15 of the most common hashtags, three of your competitors are using, and keep relevant by always using those. Also use a branded hashtag with your company's name,” Tash writes in an email to The Aesthetic Channel.

Mr. TashCosmetic practices should also plan ahead, scheduling their social media strategies one month in advance. To learn what works best for a particular practice, rotate social media messaging to address different aspects of an individual practice and see which performs best.

“Is it testimonials, before and after pictures, is it doctor's advice clips, or just plain tips on maintaining your appearance [that works for your practice]?” he asks.

Done right, social media campaigns should bring in a steady growth of followers and website referral traffic, more visibility and social validation, according to Tash. 

Royal Biologics (Jersey City, N.J.) has launched a new amniotic stem cell product to treat a multitude of conditions across several fields of medicine, including aesthetics.

Amnio-Maxx is derived from human amniotic placental tissue and comes in two forms: liquid amnion and dehydrated dual-layer patches.

Amnion, which is placental tissue that surrounds and protects the fetus during development in utero, consists mainly of fibrillar and membranous collagens, plus elastin and a mix of cytokines and growth factors, which are unique properties to placental tissues. Besides benefiting the growing fetus, these properties have been shown to treat and protect a wide variety of wounds, while concurrently creating an environment conducive to the regeneration of healthy tissue.

Royal Biologics declined to be interviewed for this story because cosmetic surgery is an off-label application of Amnio-Maxx. However, in a press release, company CEO Salvatore Leo stated that “studies in published literature support the successful and safe clinical use of repurposing this versatile tissue to improve outcomes in wound management. This tissue, including amniotic fluid, can be utilized safely in a variety of surgical and clinical settings, and can develop into various tissue types including skin, cartilage, cardiac tissue, nerves, muscle, and bone.”

Amnion has been successfully used in a range of clinical settings. Applications include spine and neurologic surgery, bariatric surgery, sports medicine, wound care and trauma. And Amnio-Maxx itself has demonstrated significant benefits: a safe, natural covering that enhances normal wound healing outcomes; reduced inflammation; decreased fibrosis and scarring at the surgical site; and decreased pain.

To ensure safety and maximize the performance of each graft, Amnio-Maxx is sterilized using a proprietary process. The collection of the donor tissue is also aseptically performed by licensed tissue establishments.

In addition, all placentas used are from planned C-sections to minimize potential contamination during recovery. Placental donors are also tested to confirm they are disease-free.

Cosmetic practices looking to diversify their skin rejuvenation modalities beyond laser and injectables can now offer their patients an effective and versatile radiofrequency platform: the Cynosure TempSure Envi from Hologic Inc.

The FDA-approved advanced radiofrequency (RF) device minimizes facial fine lines and wrinkles, tightens skin through soft tissue coagulation and improves the appearance of cellulite, according to a recent press release.

Dr. Saluja“Primarily, I like that TempSure Envi is temperature controlled,” says Raminder Saluja, M.D., founder of Saluja Cosmetic and Laser Center in Huntersville, N.C. “This means that as I am treating a patient, the device is reading the real-time temperature at the treatment site to ensure that appropriate temperatures are achieved for optimal results.”

TempSure Envi also has safety controls, so that once the temperature selected has been reached, the device will cease RF delivery, then resume once the temperature falls below the selected temperature.

“In essence, there is feedback temperature sensing, to not only achieve the selected temperature, but also to not exceed the selected temperature,” Dr. Saluja tells The Aesthetic Channel.

Dr. Saluja says this integrated monitoring adds significantly to safety. “I can trust the device to execute what I have programmed and that the treatment I am providing is accurate,” she states. “Other RF devices do not have the temperature control built in.”

Because of these safety features, Dr. Saluja is able to delegate treatment, she says.

TempSure Envi also plays a selection of spa music during treatment, “which correlates to greater comfort for the patient,” Dr. Saluja says. This is in contrast to many RF devices that emit a beeping noise during the entire treatment session, “which can be distracting.”

Dr. Saluja, who was one of the lead investigators for the Institutional Review Board (IRB) study of TempSure Envi, started using the product last September and has treated the face of 50 patients to date.

She has found success offering three to five sessions, spaced three to four weeks apart. “In my experience, treatment for the entire face takes between 20 and 25 minutes,” Dr. Saluja says. “There is also no downtime following treatment, which my patients love.”

Dr. Saluja characterizes her results as “really quite nice.” She says the device heats the deep layers of skin to regenerate collagen that improves the overall appearance of wrinkles and laxity of the face. Immediately after the procedure, though, patients “see a little ‘pop’ where their skin becomes tighter from collagen fibril contracture,” Dr. Saluja explains. “Then, over time, new collagen is laid down for a greater effect.”  

In addition, 99% of patients reported pain-free treatment, according to a Cynosure in-house study.

Without a surefire way to eliminate cellulite, cosmetic physicians and their patients are turning to combination approaches, using devices, fillers and subcision. The approaches seem to be working enough to please consumers, as more than 80% of RealSelf users rate cellulite treatment as “Worth It.” 

A new device to enter the cellulite treatment market is the Zimmer Z Wave. It uses soft pulse technology to deliver mild, consistent sound wave therapy over a series of treatment sessions. Results from the Z Wave FDA-cleared device include the temporary reduction of the appearance of cellulite.

Z Wave Treatment Details

Treating a body zone with the Z Wave generally takes from three to four minutes. Patients might see results after two or three sessions. With its 39 mm applicator head, the Z Wave transmits the radial shockwaves directly and precisely into the tissue. In addition to using Z Wave alone or in combination to address cosmetic concerns with cellulite, the device has been used as an adjunct to enhance CoolSculpting (Zeltiq/Allergan), liposuction and other body contouring and fat reduction treatments. The technology promotes angiogenesis, which reduces swelling, expedites lymphatic drainage and helps the body heal better and faster. Using it might result in skin tightening, according to press information.

Where the Z Wave Fits in the Cosmetic Practice

Dr. SasakiGordon H. Sasaki, M.D., a plastic surgeon who practices in Pasadena, Calif., writes in an email to The Aesthetic Channel that he has used the Z Wave for about four years.

He uses it for non-invasive treatment of grade I cellulite; as a combined approach to achieve better adjunct results after CoolSculpting; and to treat irregularities after procedures such as liposuction, abdominoplasties and for submental irregularities after neck lifts, etc.

“The ideal patient is a patient without significant skin laxity with subdermal irregularities,” Dr. Sasaki writes.

The Z Wave is different than other devices because it is an acoustic percussive device, which is well controlled and can be tailored to the patient’s needs. That differentiates it from other sound wave percussive devices, according to the plastic surgeon.

Benefits of the Z Wave are that it is effective with minimal down time to the patient, and easy for the provider, as well as cost effective. There are minimal disposables. After a number of pulses, the hand piece will need to be replaced, he says.

Disclosure: Dr. Sasaki is a clinical provider of the Z Wave but does not have financial or consulting ties with the company. 

Chin augmentation is an essential facial rejuvenation component, which can be done safely and effectively with fillers if clinicians know important aspects of regional anatomy and understand optimal patient selection, according to a recent review and practice experience published in Dermatologic Surgery.

Dr. WilsonWhile the nonsurgical approach to chin augmentation with dermal fillers has been covered in the plastic surgery and otolaryngology literature, little has been published in peer reviewed journals for dermatologic surgeons and other cosmetic physicians. To help address that, U.S. dermatologic surgeons conducted a review and shared their experiences focusing on anatomy, patient evaluation, injection technique, concomitant therapies and potential complications for the use of dermal fillers to temporarily correct chin retrusion.

“The chin should be assessed as a critical component of aesthetic harmony in all patients seeking facial rejuvenation,” says the paper’s lead author Monique J. Wilson, M.D., who is fellowship trained in cosmetic dermatology and practices in Sunnyvale, Calif. “Equipping yourself with the skills necessary to evaluate the chin, determine the best method of augmentation and combine concomitant therapies will help your patients achieve their aesthetic goals.”

NEXT: Anatomic Considerations

Anatomic Considerations

There is no single aspect of a patient's anatomy that will determine whether chin augmentation is appropriate, according to Dr. Wilson.

“Our clinical experience [and] aesthetic literature have taught us that the relative proportions of the entire face need to be considered in any patient to achieve the optimal aesthetic result,” Dr. Wilson says. “As chin retrusion is often unnoticed by patients and untreated by aesthetic providers, we recommend careful routine evaluation of the horizontal projection and vertical height of the chin in patients seeking facial rejuvenation.”

It’s helpful to assess the chin not only in anteroposterior, oblique and lateral photographs, but also with animation, according to Dr. Wilson.

“It is often instructive to review these photos and videos with patients, as many are not aware of their chin retrusion or how it impacts their appearance,” she says.

For example, the authors report that it’s common for patients seeking rhinoplasty not to realize that chin retrusion can give the impression that a nose is larger than it is.

NEXT: Best Practices

Best Practices

Clinicians can effectively use hyaluronic acid, autologous fat calcium hydroxylapatite and poly-l-lactic acid to augment chins. But the best filler choice depends on, among other things, the patient’s anatomy.

The authors cite research on chin augmentation in Asian patients, which found high-viscosity hyaluronic acid or calcium hydroxylapatite fillers were best. Authors of this paper suggest those same filler types effectively improve the anterior, transverse and vertical chin dimensions.

“The properties of fillers inform our use. Those with greater ‘lift’ are typically used deeper, in a more depot-like fashion to increase chin size, while other fillers are more appropriate for superficial injection and blending,” she says.

The paper’s authors use a combination of depot and threading techniques.

And similar to implants in the cheek, chin implants are often combined with fillers to achieve best results.

“Over time, age-related bone resorption may result in an obvious or unnatural appearing chin implant. This effect can be minimized through the use of fillers to blend and soften the chin,” Dr. Wilson says.

Potential complications of filler use in the chin are similar to those that might occur with use elsewhere in the face, according to Dr. Wilson.

“Of particular concern are contour irregularities that may result from superficial injection and vascular compromise.

Often, patients require concomitant therapies to achieve their desired results, she says.

“Perhaps the most common technique is injection of fillers to treat volume loss along the mandible or in the lips, mental crease, marionette [lines] and oral commissures,” Dr. Wilson says. “Most patients with chin retrusion also benefit from neuromodulator injection to the mentalis, as it is often hyperdynamic in this population. Other surgical, injection and device-based therapies to address skin laxity, submental fat accumulation and platysmal bands can also be combined with chin augmentation for superior results.”

Disclosure: Dr. Wilson reports no relevant disclosures.

A task force representing plastic surgery societies is urging practitioners to reevaluate performing gluteal fat injections (Brazilian butt lift). This comes on the heels of new recommendations for making gluteal fat injections safer due to concerns about deaths from the procedure.

The multi-society Gluteal Fat Grafting Task Force chaired by Dan Mills, M.D., J. Peter Rubin, M.D., and Renato Saltz, M.D., reports that every surgeon performing the Brazilian butt lift should “immediately” reevaluate the way he or she does it.

All autopsies of deceased [Brazilian butt lift] patients have had four things in common, according to the statement: “fat in the gluteal muscles; fat beneath the muscles; damage to the superior or inferior gluteal vein; and massive fat emboli in the heart and/or lungs.”

Their findings indicate that surgeons injected more deeply than intended because none of the postmortem cases of death had fat in the subcutaneous space, only, they write.

Dr. YounDetroit, Mich., based plastic surgeon Anthony Youn, M.D., who is not part of the task force, points to these taskforce recommendations for avoiding complications related to the procedure:

1. “Stay as far away from the gluteal veins and sciatic nerve as possible. Fat should only be grafted into the superficial planes.”

2. “Concentrate on the position of the cannula tip throughout every stroke to ensure there is no unintended deeper pass….”

3. “Use access incisions that best allow a superficial trajectory for each part of the buttock; avoid deep angulation of the cannula….” Make sure the cannula tip remains superficial.

4. “Use instrumentation that offers control of the cannula….”

5. Injections should only be done while the cannula is in motion.

6. “The risk of death should be discussed with every BBL patient.”

Sometimes, Dr. Youn says, other procedures work well to enhance the buttocks.

“In many patients, contouring the periphery of the abdomen, using liposuction or non-invasive fat reducing methods, can provide a reframing of the buttocks that may be sufficient to make patients happy. Many doctors are also injecting Sculptra off-label for buttock enhancement,” he says.

When talking with patients about the Brazilian butt lift, Dr. Youn says he explains the surgery and the risks involved, especially with larger grafted volumes, and makes sure the patient is aware and agrees to proceed if he and the patient both deem it safe and necessary.

“Currently the mortality rate for this operation is unacceptably high, and I praise [the American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery and International Society of Aesthetic Plastic Surgeons] on taking the initiative to tackle this issue head on, providing plastic surgeons suggestions on making this procedure as safe as possible. However, I do believe that if we can make our patients happy without having this surgery performed, that should be considered,” Dr. Youn says.

According to the advisory, The Inter-Society Gluteal Fat Grafting Task Force represents the American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgeons. The International Society of Plastic and Regenerative Surgeons and the International Federation for Adipose Therapeutics and Science provide scientific support.

Disclosure: Dr. Youn is a consultant for Allergan, a shareholder in Alphaeon and Strathspey Crown, and a luminary for Invasix and Cynosure.

The human immune system might provide protection from recurrent bacterial skin infections caused by Staphylococcus aureus (staph), thus leading the way to effective vaccines, according to recent findings in The Journal of Clinical Investigation, which examines both an animal (mouse) and human study.

A vaccine to combat methicillin-resistant staph aureus (MRSA) is desperately needed because of declining antibiotic development and rising drug resistance.

“Immunocompromised mice that had an impaired immune response against an initial exposure to MRSA in the skin were surprisingly completely protected against a second skin exposure to MRSA,” says senior author Lloyd Miller, M.D., Ph.D., an associate professor of dermatology at the Johns Hopkins University School of Medicine. “However, it took us a while to figure out how this occurred because the protection was not mediated by typical antibody responses that most vaccines against MRSA are targeting.”

Rather, the investigators found that a single population of T cells (so-called γδ T cells) had a massive expansion in the skin-draining lymph nodes, increasing from less than 1% to more than 20% of the T cells present.

“These cells then migrated to the skin and protected the mice against a second exposure to MRSA,” Dr. Miller tells The Aesthetic Channel.

Separately, in collaboration with the National Institutes of Health (NIH), the investigators discovered that adult humans with a rare condition making them highly susceptible to MRSA skin infections in childhood had a similar expansion of these T cells in their blood when they became adults and were no longer predisposed to infection.

“This suggests that a similar protective response that we found in mice might also occur in humans,” Dr. Miller says.

Dr. Miller notes there are several pharmaceutical companies in FDA Phase II studies evaluating passive and active vaccines against certain types of MRSA infections in humans, including postsurgical MRSA infections and protection against MRSA pneumonia that can be life-threatening for ventilated patients in hospital intensive care units.

“Hopefully, such vaccines will promote protection in these specific infections,” Dr. Miller says. “The use of vaccines could also be expanded to protect people from MRSA skin infections and other types of infections like skin abscesses, sepsis and osteomyelitis.”

The published article suggests that in addition to antibodies, “T cell responses should be looked at in human vaccine trials against MRSA,” Dr. Miller concludes.

Mr. AllenFrom construction periods and improvement allowances to renewal options and subleasing rights, negotiating an office lease requires forward thinking and research. Thomas Allen, founding partner of Practice Real Estate Group, a full-service healthcare real-estate solutions company based in Austin, Texas, offers seven considerations for negotiating one in your favor.

1. Square Footage

Square footage of the leased space is the first consideration. “Try to come up with a plan for the business and understand how much square footage is needed, as close as possible prior to submitting a letter of intent,” says Allen.

2. The Construction Period

Second is planning for the time it takes to build out your office. “Therefore, you need to negotiate a construction period, whereby you do not pay any sort of rent until the new construction is completed,” Allen tells The Aesthetic Channel. Typically, a construction period is between 120 and 150 days.

3. Lease Length

The length of the lease is also important. “Normally, the longer the term, the more concessions you are able to secure from the landlord,” says Allen, noting that for most medical spaces the lease should be seven to ten years.

NEXT: Rent Amount and Structure

4. Rent Amount and Structure

The amount of rent and how it is structured can take several forms, including a gross lease, a triple net lease (base rent, plus taxes, insurance and common area maintenance) or a gross lease plus electricity. “Most leases in most markets are triple net leases, for which you should try to negotiate some sort of cap on how much the triple nets can increase over time,” Allen explains. “Because these expenses are variable and you have no influence over them, you want to ensure that the landlord has a motivation to control the expenses on the building.”

5. Improvement Allowance

A tenant improvement allowance is also desirable. “This is money the landlord gives you to help you build out your space,” Allen says. “Rarely will this amount cover all expenses, but you can receive a substantial sum of money, depending on your rental rate and the length of the lease.”

6. Renewal Options

Renewal options should also be included in an office lease; otherwise, the landlord can demand that the practice vacate at the end of the lease or use the lack of renewal clauses to pressure the practice to pay an exorbitant rent upon expiration.

Allen recommends two 5-year renewal options, which on a 10-year lease allows the practice to stay for a total of 20 years. “You might negotiate a fixed renewal rate at the time of the original lease, but more likely a market rate at the time of renewal,” he says. “However, if you choose the former, you may be able to negotiate a lower renewal rate at the completion of the original lease.”

Renewal rates can also be based on the consumer price index, which is set by the government for inflation.

7. Exclusivity

Another negotiating tactic is to insist on exclusivity, so that the practice is the exclusive provider for a particular medical specialty within the landlord’s overall leased space.

“You also want to retain lease assignment and subleasing rights for your space, in case you want to sell the business or sublease to some other type of provider,” Allen notes.

Finally, consider hiring a real estate broker who represents medical tenants to negotiate all the above items, Allen advises.

Read More articles in this series:

In search of office space

Building your practice (literally)

Opening a second practice

Eyebrow microblading and laser-based vaginal rejuvenation are two treatments that are spurring growth for medical spas, according to a recent industry report.

Mr. Thiersch“I think everyone has to be surprised with the way that microblading has come on the scene: the reception, the profit and the patient demand,” says Alex Thiersch, J.D., founder and director of the American MedSpa Association (AmSpa), which released the report based on data from surveying roughly 500 U.S.-based medical spas.

Thiersch is also surprised by the continuing high-level patient satisfaction of vaginal rejuvenation. “Since becoming truly popular two years ago, we are still seeing patient satisfaction rates in the 90% range, sometimes 95% and higher. This is basically unheard of,” he says.

On the other hand, Thiersch tells The Aesthetic Channel he is amazed by the lack of growth among male clients. “Industry experts have been predicting an increase in the male patient population at med spas for years, but it has held steady at 15%,” he said. “Men represent close to 50% of the population and we know that they have many of the same concerns as women when it comes to aging, but that is not translating into the marketplace as much as we thought.”

Thiersch is optimistic, however, that as men age, “they will undoubtedly come around. It is just taking a little longer than we thought, so perhaps as an industry we need to rethink how to reach this population.”

Meanwhile, Thiersch encourages med spas to continue to focus on what brings patients though the door, namely injectables. “Botox, Dysport and fillers still dominate the industry,” he notes. “Study after study has found that these are the treatments that people are most curious about. “

And although it is easy for med spas to become distracted by new treatments and fancy machinery, “the beating heart of the aesthetics industry is, and will continue to be, injectables,” Tiersch states. “Injectables are still the most reliable way to attract patients, and with developing efficiencies and increasing innovation we are seeing practices make a lot of money from injectables.”

Longer-lasting botulinum toxin injections are also on the horizon.

The report also found that 50% of medical spa owners expect that their revenues will increase by more than 10% in 2018.

Moreover, with many states attempting to define what procedures can be performed by what disciplines, nurse practitioners will likely play an increasingly larger role, according to Thiersch, including serving as de facto medical directors when doctors are off-site.