Sponsored by BTL Aesthetics

Savvy aesthetic practitioners are positioning the powerful capabilities of the revolutionary Emsculpt and Emsculpt Neo non-invasive body sculpting systems from BTL Aesthetics (Boston, Mass.) to build their practices. The nature of therapy with these remarkable devices serves both preventative and corrective functions, with broad appeal to patients of any age, gender or ethnicity.

“‘Build muscle, burn fat’ is a compelling promise for any and all patients, and the Emsculpt devices deliver,” said plastic surgeon Brian Kinney, MD (Beverly Hills, Calif.). “This means different things to different people, but it applies: if you want to be an active, rather than a passive, participant in life at any age, Emsculpt is for you.”

Emsculpt Classic and Emsculpt Neo use high-intensity focused electromagnetic (HIFEM) energy to stimulate supramaximal muscle contractions in target areas which induce scientifically demonstrated muscular hypertrophy and hyperplasia. By itself, this upregulates local metabolism, causing localized fat reduction. If desired, Emsculpt Neo adds the innovative component of simultaneous RF emission, which enhances these therapeutic effects.

“Simply put, what injectable neurotoxin did for the industry through facial injectables a few decades ago, the Emsculpt devices are doing again through non-invasive body contouring,” said cosmetic dermatologist Paul J. Frank, MD, medical director of PfrankMD in New York, N.Y. “With these devices, BTL created a whole new treatment category that appeals to anyone looking for functional, corrective or aesthetic improvement. The safety, ease of use and outcomes provide an essential adjunct to any body contouring practice as well as a steppingstone to this market for any aesthetic physician.”

“This attracts three key markets,” he continued. “It appeals to the younger demographic and men because it transcends the diminishing returns usually experienced with
traditional lifestyle pathways to a beach body, and to older patients who want to retain or restore core strength for functional reasons. This has augmented and further opened up my body sculpting practice considerably.” Although originally directed at the core musculature, the Classic platform features additional handpieces for skeletal muscles of the extremities; similar functionality for the Neo is also available.

The Core-to-Floor treatment concept harnesses the core muscle enhancement of Emsculpt and the pelvic floor restoration with the Emsella chair applicator to give older patients mobility, range of motion and more, which they may have lost. “This is the most magnificent marriage of two technologies I have ever seen, and there is nothing else like it,” said David Kent, MD, founder of Skin Care Physicians of Georgia (Macon, Ga.). “The Emsculpt devices are a gateway into our practice. For Baby Boomers, improved core and skeletal musculature serves aesthetic purposes but, more than that, a wellness component for maintaining basic function.

“Furthermore, the Emsella chair applicator addresses the pelvic floor to improve issues such as incontinence as well,” he continued. “Millennials are much more information-seekers and come in knowing exactly what they want. They are busy and much more image- and wellness-conscious, so they easily see the benefit of Emsculpt. For any demographic, after successful therapy, it is only natural for them to inquire about our other aesthetic treatments.”

Dermatologist Bruce Katz, MD, is director of JUVA Skin & Laser Center (New York, N.Y.). “Traditionally, body sculpting was for younger, fitter patients and mommy makeovers. The unique effect of the Emsculpt devices allows us to go well beyond that and treat just about anybody. Also, because Emsculpt Neo can treat higher-BMI patients – even patients with a BMI of 35 – this provides possibilities for segments of the market we couldn’t effectively treat before, and that is a big deal as well.

“As we emerge out of COVID-19, many people have put on a few pounds and lost muscle tone, often stuck at home and not able to get to the gym, and maybe even feeling depressed, which never helps any aspect of wellness,” Dr. Katz continued. “They are looking to enter, or re-enter, the practice to get back to themselves in terms of appearance, function and overall quality of life. Build more muscle, trim more fat as we transition out of COVID and into summer; that is what many people are eager to do. Emsculpt can be a huge part of that, and the traffic in our practice is the proof.”

Suneel Chilukuri, MD, founder of Refresh Dermatology in Houston, Texas, treats many Baby Boomers. He notes that the functional improvement prospects are extraordinary for a variety of reasons. “First you have improved functionality and wellness, which cannot be overstated,” he began. “After age 30 people lose a few percentage points of muscle mass each decade! I gave my father- in-law four treatments, and he went home skeptical, but later thanked me profusely because the core strength and quadricep enhancement made it much easier for him to get around.

“Nevertheless, we also have major societal issues, currently and in the near future, that impact us all,” he continued. “Self-interest makes Baby Boomers health conscious, so they spend millions on supplements and functional foods like probiotics. Billions of dollars are spent annually on healthcare due to reduced health and function in the older population. Back pain represents a huge percentage of medical complaints. Pain plus loss of strength and balance causes falls, which leads to suffering and even death among the elderly. The cost to the family and to society is tremendous from both a psychological and financial sense. More mature men and women are working later in life due to the economy. Without a doubt, addressing core function with the Core- to-Floor protocol makes a huge difference to quality of life for patients. I have seen it repeatedly.”

The issue of disposable income is a challenge and an opportunity, Dr. Chilukuri added. “Millennials have maybe 10% to 20% of the disposable income of Baby Boomers, but much more drive toward a healthy lifestyle, maximum self-image and overall wellness. Awareness leads to interest among that population, and after some research they take action. The Baby Boomers have much more spending power, so awareness of the functional improvement is a powerful driver.”

“Emsculpt almost sells itself,” Dr. Kinney stated. “I call the devices ‘money-happiness machines’ because within a few seconds people say ‘Wow, something’s happening,’ and they leave the practice with an endorphin rush, feeling good about themselves. Millennials think Emsculpt is cool and hip and fun; the older generation feels rejuvenated and enjoys renewed confidence.”

Sponsored by Aesthetics Practice Accelerator (APX)

If I asked you what your revenue per hour is per room or per provider, would you be able to tell me?

If you can’t answer this off the top of your head or even by looking at your financials, don’t worry. You are not alone. Industry benchmarking data shows a surgical practice should generate approximately $3000 per hour; a medical spa between $600-$1000 per hour; and an aesthetician room between $250 to $350 per hour.

If you are not quite there, it usually means a few things:

1. Prices are too low
2. The provider is taking too long in the room per treatment/surgery
3. You may not be offering the right mix of services

Now, more than ever, in this COVID era of seeing and treating a reduced capacity of patients per day, it is imperative to maximize the time you spend on procedures and services that generate the highest revenue potential.

Numbers You Must Know

In order to determine your revenue per hour, you need to look at your service category mix over a period of time – three months, six months or 12 months. Then, you need to know:

• What are you charging per service?
• What is the cost of labor?
• What is the cost of goods that is associated with that service?
• How long does it take the provider to perform that service?

Why Revenue Per Hour Matters

Knowing this number is critical to making informed decisions on the types of services you provide and your price per service. Once you determine your revenue per hour, you can then decide which services you want to eliminate or reduce, and which ones you want to do more of instead. This information gives you the opportunity to course correct and fix things that are out of alignment.

Knowing your revenue per hour gives you a very clear picture of many things, including:

• Insight into your pricing and whether you are aligned with your market
• Ability to determine your marketing spend to lower your customer acquisition cost and raise your ROI
• Data on productivity per hour
• Financial perspective on gross profit by knowing your revenue less the costs of goods and labor. If it is not 50% or greater, you are losing money.

At the end of the day, we all want to provide great results in a safe manner and have a profitable business. So, knowing what percentage of your annual revenue is being generated from each category of service is fundamental. It gives you a snapshot of your full financial picture so you can make changes that will immediately have an impact on your business.

Aesthetics Practice Accelerator (APX), our newly launched business intelligence growth platform, includes a comprehensive financial foundations course designed to help you learn how to extract critical data from your EMR/Practice Management Software and then plug it in to one of the seven financial optimization calculators included so you can make the best, most informed decisions to increase profitability.

About the Author

Terri Ross

Terri Ross is a world-renowned practice management consultant and international speaker who has helped hundreds of medical aesthetic practices launch, grow and scale to upwards of $1M in revenue growth a year and beyond. Terri was an executive for Fortune 500 Medical Device Companies managing sales team ranking in the Top 10%. In addition, Terri was a managing partner for a medical spa in Beverly Hills, which she scaled to $3+M. In response to real-world challenges facing aesthetic practices, Terri launched APX by Terri Ross in 2021 – an integrative training and growth platform that provides solutions for the medical aesthetics industry in the areas of sales, finance and operations.

Sponsored by Air-Tite Aesthetics

Air-Tite Aesthetics (Virginia Beach, Va.) is the U.S. distributor for TSK Laboratory’s flagship STERiGLIDE^TM microcannulas. Owing to its patented design for easy cannula introduction, accurate filler placement and optimal patient comfort, STERiGLIDE is the premium cannula of choice for many of the profession’s most influential injectors.

TSK introduced this newly redesigned cannula to the market in 2012. Its improvements in fit, form and function soon set it apart from all others. In 2015, STERiGLIDE was awarded the prestigious Anti-Aging and Beauty Award as the “Best Injection Tool” in the industry. Specifically designed and improved by some of the profession’s key opinion leaders working with TSK’s engineers, it soon became recognized as the gold standard around the world.

STERiGLIDE microcannulas are made of the highest quality stainless steel with the addition of a proprietary surface treatment for reducing friction within the tissue planes. This reportedly minimizes patient discomfort, while improving cannula control. This innovative product enhances an injector’s technique and their patient’s experience. It was developed to be a true second-generation instrument, quickly progressing to the forefront of cannula usage.

The construction of the microcannula is slightly stiffer than most, allowing for enhanced control and precision in product placement. The hard polymer hub has a clear side-port marking which indicates the direction of the needle port while acting as a visual aid for the most accurate filler delivery.

Compared to a traditional cannula tip, the tip of the microcannula has a patented dome-shaped design which creates less resistance, thus easing insertion at the injection site while potentially reducing pain and bruising.

STERiGLIDE possesses the nearest to the tip delivery port, which enhances visualization and delivery of the filler near the end of the cannula, creating a more accurate sense of filler placement. It also reduces the potential for expensive product loss captured within the tip location of other cannulas.

Practitioners can easily locate and palpate the end of the cannula tip within the soft tissues. With the extrusion port being so near to the tip, it mimics the accuracy of a hypodermic needle, while reducing the possible side effects of swelling, oozing and bruising. Patients comment on having less pain as the cannula glides along its intended path.

The most popular dermal filler products available today have many different viscosities. The STERiGLIDE tube has an ultra-thin wall inner diameter, which allows the injection of many products with relative ease and less extrusion pressure. The hard polymer material and design of the STERiGLIDE hub offers reassurance that “pop-off” may be a thing of the past.

Coming soon in 2021, TSK will add a ninth member to the STERiGLIDE microcannula family, the much anticipated 22 G x 38 mm (1.5”) size. With many new indications for the larger gauge sizes, the 38 mm length will nicely complement the existing 50 mm and 70 mm products.

Editor’s Note: To learn more about the STERiGLIDE difference or to request free microcannula samples, please contact Air-Tite customer service.

Sponsored by Aesthetics Biomedical, Inc.

Aesthetics Biomedical®, Inc. (Phoenix, Ariz.) re-established the standard for aesthetic conferences with its inaugural symposium, Perspectives: The Evolution of Aesthetics, held at the J.W. Marriott Phoenix Desert Ridge Resort & Spa April 9-10, 2021. The event was designed to spark discussion around the past, present and future of the industry. Aesthetic luminaries shared their ideas and viewpoints together with content on emerging trends, new therapies and technologies, best practices, and various aspects of marketing and social media management to foster learning, inspiration and growth. More than 200 attended the conference, which was held in a private, socially distant environment. Many more attended virtually.

“Like a lot of others here, this is the first in-person event I have attended since COVID-19,” said Vivian Bucay, MD, dermatologist, founder and president of the Bucay Center for Dermatology and Aesthetics (San Antonio, Texas). “This is a sponsored symposium, but highlighted perspectives and philosophies of care, as well as the evolution of how we treat patients, from skincare to device-based therapies, as well as combination treatments. Aesthetics Biomedical (ABM) assembled an impressive group of top thought leaders, and speakers were invited for their expertise and opinions, not to echo the agenda of sponsors. And because of the pandemic, it has been a long time since most of us have had the opportunity to experience this level of quality and variety of ideas and perspectives in our field.”

“What ABM has done here is simply amazing,” said Lori Robertson, MSN, FNP-C, owner and clinical director of Skin Perfect Medical and of The Aesthetic Immersion (both in Brea, Calif.). “For the launch of a new conference, everything here has been top notch, from the presentation and overall organization, to the videos and lighting, to the educational content and food, not to mention the lineup of speakers. A variety of companies and products were represented in an intimate setting that still affords safety and social distancing, with a lot of little twists, turns and unexpected touches. Obviously, a lot of out-of-the-box thinking went into this symposium.”

“Oftentimes, when we attend events like this there is information overload,” added Ava Shamban, MD, cosmetic dermatologist and owner of Ava MD and Skin Five (Beverly Hills, Calif.). “Here, we also had space and time to truly encounter other things, receive treatments, enjoy hands-on experiences, and learn about new technologies in depth. It was more compact but still featured a spectrum of offerings; and because of their many partnerships the exhibits were more diverse than one would expect. I believe attendees got a lot more out of this than they might at a traditional meeting. It was a totally different experience for me.”

Keynote speaker Shino Bay Aguilera, DO, dermatologist and dermatologic surgeon at Shino Bay Cosmetic Dermatology in Ft. Lauderdale, Fla., shared his perspectives about the initiative of inclusion and diversity in aesthetic medicine. “This is not about ethnicity or race, but we must recognize that for a long time we have been very Euro-centric. Only now are we embracing the beautiful diversity among patients and their unique physical, emotional and cultural needs,” he explained. “As we continue to learn more about all types of skin and how different therapies and energy-based devices interact with them, we have more capability and greater responsibility to be a part of this beautiful diversity. This acknowledges some things we know and challenges others, which is exactly the kind of experience this symposium was designed to achieve. This event has been a positive experience and a great environment for inspiration in our industry.”

Dr. Aguilera also spoke about the evolving wellness paradigm and the importance of spirituality – no surprise to those who know of his passion in the space. “Spirituality is important because wellness comes from within,” he said. “Nothing prevents aging like a positive, healthy outlook and the management of unnecessary stress. Everyone knows that stress ages you prematurely, so our best practice should be to treat not only the physical, but address wellbeing as a whole.”

SoME^® Skincare and the Vivace^® Fractional Microneedle Radiofrequency (RF) technologies were showcased, along with those from numerous partners, among the exhibits. The first home skincare product based on autologous platelet-rich plasma (PRP), SoME Skincare provides peerless skin maintenance therapy, according to Dr. Bucay. “In-office treatments don’t address oxidative stress and free radical damage in a way that combats these things on a daily basis. SoME Skincare does this wonderfully, with the patient’s own PRP and other compounds that promote healthier skin in daily maintenance use, and can be used adjunctively with other therapies to improve healing and maximize outcomes.”

“SoME Skincare also represents an ideal vector given the trend toward more natural, regenerative therapies, which appeals to a lot of patients,” she continued. “People have become more careful about what they ingest or put onto their skin. By being composed of autologous PRP and safe, effective, proven compounds, it satisfies this growing need.”

With its array of 36 insulated gold-tipped needles and 31 insertion depths, Vivace delivers unrivaled minimal-downtime radiofrequency (RF) microneedling for all skin types via targeted RF delivery, coupled with microneedle induction of collagen. It also creates channels for infiltration of compounds safe for use with microneedling. “Patients choose Vivace,” said Ms. Robertson, “because for many of them the prospect of social downtime may be unacceptable. Also, these beautiful results seem to evolve naturally over time, so busy professionals can undergo treatment and gradually improve without the cost of downtime. We can combine Vivace with other things such as a very light CO₂ peel and get out-of-the-park results.”

“The customizability of Vivace Fractional Microneedle RF lends itself incredibly well to treating the diverse presentations of patient skin on the face and body, for the range of conditions we treat,” said Dr. Shamban. “Vivace’s array of insulated needles, with 31 choices for depth of insertion, really opens up RF microneedling to darker skin types that I think have been left out of the rejuvenation market. It embodies the philosophy of embracing diversity that has been so prevalent at this event. That is why I have two of them.”

“In ABM we are seeing a young, modestly sized company doing things in such a big way that it is inspiring to me, and I am sure to my colleagues as well,” Dr. Bucay added. “This has been a thorough, seamless and authentic experience that resonated with me. ABM is behaving not just like a serious company, but a community leader.”

“They have created a buzz that is not just a wonderful kick-off to future events from Aesthetics Biomedical, but to the industry as we fight to emerge from the pandemic,” Ms. Robertson said. “I can’t wait for the next one.”

Sponsored by Saratoga Aesthetics

After charming the international community, the Endolift® procedure from Eufoton (Trieste, Italy) is now available in the U.S. exclusively through Saratoga Aesthetics (Eufoton USA). As a preferred nonsurgical option for lifting, tightening and the removal of excess fat, Endolift is an innovative, minimally invasive procedure that can be used on the face, neck and body to stimulate both deep and superficial layers of the skin, causing the connective septum to retract and stimulate collagen remodeling. This single-session procedure achieves immediate and notable effects, with results that are further enhanced over time.

A key differentiator with Endolift is the hair-thin, bare optical fiber (200 or 300 micron) that is connected to Eufoton’s LASEmaR 1500 diode laser and inserted into the superficial hypodermis. This avoids the mechanical and thermal trauma caused by a metal cannula. Roberto Dell’Avanzato, MD, an aesthetic surgeon in Milan, Italy, and International Member of the American Society of Plastic Surgeons, explained that the wavelength is manipulated by the optical fiber. “It heats to 65° to 70° Celsius to create collagen remodeling, while the surface skin maintains a comfortable temperature of lower than 40° Celsius.”

Dr. Dell’Avanzato developed Eufoton’s Endolift procedure more than a decade ago and has successfully used it to treat the entire face and body. He continues to refine the procedure and is on the cutting-edge, pushing boundaries with improved ways to treat incredibly delicate areas, like under the eye. Treatment of this region traditionally relied on a metal cannula, which carries the risk of complications related to overheating.

For Mehrnoosh Heidarian, MD, a board-certified dermatologist in Tehran, Iran, Endolift has been a significant part of her practice for four years, during which time she has performed more than 300 procedures. “The results are remarkable, comparable to a conventional surgical facelift,” she expressed. “No anesthesia is required, no scar, no bleeding, literally zero downtime.”

While the Endolift technique is typically used for lifting, tightening and definition on the mid and lower face, mandibular border, chin and neck areas, in Dr. Heidarian’s experience, the Endolift technique is an exciting option for cutting through the fibrotic bands at the bottom of acne scars to improve their appearance in a non-traumatic way. Laser-assisted subcision with this evolved technique, she explained, is more effective than the former cannula-assisted subcision.

Michael Felton, MD, a lead trainer for Eufoton USA and director of Nouveau Visage Anti-Aging Center & Med Spa in Broussard, La., describes the LASEmaR 1500 as the “Swiss Army Knife” of aesthetic devices. He elected to add the Ladylift® capabilities for vaginal treatments and LIGHTScan, a non-ablative fractional scanner, to his LASEmaR 1500, in addition to Endolift. Dr. Felton considers the laser to be the most impactful device he has added to his practice. The laser’s versatility and proven procedures ensure high patient satisfaction and a high return on investment. 

According to these experts, Endolift checks all the boxes on a practitioner’s 2021 aesthetic procedure wish list, helping to create a favorable outcome for their patients. Dr. Felton acknowledged, “If you are a hands-on surgeon like me, then it is definitely a tool worth adding because you can expand your utilization as your comfort level grows. It is so far advanced in its offerings and capacities beyond the other technologies that we have,” he explained.

Today’s consumers are neck focused. They look at their necks on Zoom calls, they stretch on selfies to reveal a more streamlined neck contour. And, they are visiting cosmetic practices for treatment options.

Invented by Beverly Hills, Calif.-based, plastic surgeon Gregory Mueller, MD, FACS, MyEllevate (Newport Beach, Calif.) is a surgical suture system that offers today’s patients what they want in a minimally invasive cosmetic necklift.

“MyEllevate fills a very important niche for a minimally invasive in-office procedure that provides lifting and contouring of the neck, including sagging skin, herniated submandibular glands, and even the vertical and horizontal neck bands,” said John R. Burroughs, MD, a fellow of the American Society of Ophthalmic Plastic Surgery and medical director of Springs Aesthetics in Colorado Springs, Colo.

MyEllevate is not the first suture elevation technique for ptotic neck tissue concerns, but it is different in that it offers ICLED technology, which allows precise placement of the suture in the optimal plane between skin and underlying platysma.

“The stiff suture rod facilitates passage through eight small puncture sites,” Dr. Burroughs noted. “The suture is solidly attached centrally on the lighted rod, and I have had no incidence of suture detachment. The provided adhesive template standardizes optimal puncture site placement that follows ideal submandibular angle alignment yielding a very natural appearing multivector lift.”

Ideal Candidates & Patient Expectations

Ideal candidates for MyEllevate treatment have mild-to-moderate submental skin sagging with loss of an aesthetic cervicomental angle; mild vertical platysmal bands; horizontal neck lines; and displeasing submandibular contours from protruding submandibular glands. Other suitable candidates include those with more significant skin sagging, platysmal bands, deep horizontal neck bands, and even horizontal rolls of skin in the lower neck, according to Dr. Burroughs.

Providers generally achieve optimal results treating skin with good elasticity. MyEllevate might not be the ideal treatment option for those with severe amounts of sagging skin; very wide and prominent platysmal bands; hypertrophic herniating submandibular glands; significant subplatysmal fat; microgenia; and exceptionally low hyoids.

Dr. Burroughs helps patients envision potential outcomes by having them look at their necks in a mirror while using a 3-point fixation (thumb centrally, middle finger under the submental angle, and the ring/small finger laterally) to pull and lift the neck skin. The maneuver, he said, can also be done unilaterally so patients can self-assess the improvement to the other side.

MyEllevate appeals to a wide array of patients, including those wanting to rejuvenate neck tissue ptosis.

“Many who are trying to prejuvenate, seek the MyEllevate procedure to improve early changes without having to undergo incisional surgical techniques,” Dr. Burroughs pointed out. “Additionally, those that want an in-office procedure with just local anesthetic rather than deep sedation or general anesthesia, find the MyEllevate procedure very appealing. Recovery is exceptionally fast, and many can work the next day, but they are discouraged from any neck flexion or exertional activity for two weeks.”

Dr. Burroughs often uses MyEllevate in combination with other procedures, including with subdermal radiofrequency technology to further tighten and lift sagging neck skin.
“Many patients also have either familial or acquired excess fat of the neck that requires concomitant suction aspirationliposuction,” he said.