Selecting the Best Devices When Starting Out

I believe one of the most valuable aspects of attending conferences such as ODAC is to “fill in the gaps” in important topics that are often missing in our regular dermatology training. While US dermatology residency programs provide the foundation for providing the highest level of dermatologic care to our patients, they are often lacking in teaching the business side of medicine and practical tips on starting or working in the private practice setting. Therefore, I am thrilled to summarize for you the excellent talk “Selecting the Best Devices When Starting Out” given by Nazanin Saedi, MD at the 2021 ODAC conference.

According to a 2018 ASDS survey, the number of non-invasive procedures has grown exponentially with 3.5 million laser/light/energy-based procedures performed by board-certified dermatologists in 2018, with the top two most common conditions treated being wrinkles (809,000) and sun damage (786,999). If you were to follow this data to make a device purchase decision when starting your practice, would you purchase a device for wrinkles and sun damage? Maybe, but not necessarily. Dr. Saedi’s recommended first step when purchasing a device is to gauge the market you are in, with these three components of Market Analysis¹:

    1. Personal skillset: You must be comfortable with the procedures you are offering and, just as importantly, how to manage their complications! For example, if you are not comfortable doing really aggressive procedures, purchasing a fractional CO2 laser might not be the best device to start off with.
    2. Consumer Demand
      • Gauge interest using patient intake forms and online forms.
      • Look into what aesthetic concerns your patients have (i.e., vessels, pigment, excessive hair, wrinkles?). This is important to understand BEFORE you offer new services.
      • Be in touch with the local market, not the latest trend on social media or what other people are doing across the country.
    3.  Competitive Opportunities: research your competition to understand what other aesthetic providers in your area are offering to avoid being redundant (i.e., you don’t want to purchase a device that all other dermatologists/aesthetic providers within a 2-mile radius have as well). Don’t forget to look at:
      • Medspas (LHR, IPL, Cheap prices)
      • Competing aesthetic physicians
        • Vascular, pigment lasers
        • Resurfacing lasers
        • Skin Tightening treatments
      • Set yourself apart!
        • Become an expert in the device, master the nuances.
        • Treat staff and family. The staff can better inform patients what to expect from healing and results.

As Dr. Saedi stated, it’s all about finding the right balance of what you want to do, what can set you apart from other providers in the area, and what fits your patient base.

Buying at the right time

When purchasing devices, appropriate planning and preparation can help to avoid acquiring the wrong device. There are several factors you want to consider:

        • Patient demand
        • Scheduling availability (i.e., how long will the procedure take to perform?)
        • Office Space
        • Overhead
        • Level of staff training needed. What can you delegate? (i.e. can your staff handle the procedure and/or complications if they arise?)

Finances – Return on Investment (ROI)

    • Overhead
      • Maintenance/Service Contracts. Can be up to $10,000 a year.
      • Cost of Consumables
      • Need for follow up visits –> lost revenue
    • Profit margin
    • Break-even point
    • Time demand to determine profitability
      • Calculate its amount of profit per unit of time and compare this to other devices
    • Buy ONE device at a time! Dr. Saedi recommends trying to make money on your first device before purchasing a second one. It can be a huge financial burden to have multiple devices at once when starting out.

Hidden Costs

Don’t forget to take into consideration the hidden costs that come with purchasing a new device, such as consumables, maintenance, service contracts (which can be up to $10,000 a year), and follow-up visits which equate to lost revenue.

Finance Options

    • Buying vs. renting: there are different ways of acquiring new devices. While most people buy, you also have the option (at the beginning, when starting out) of renting (which Dr. Saedi actually recommends). While it might not be the newest laser, it will let you gauge demand for that particular treatment/service and see if you have the patient base in order to take the largest step of purchasing the device.
    • Lease: most expensive option but might make sense financially as technology keeps changing.
    • Used device: If you are considering buying a used device, Dr. Saedi cautions people to make sure it is not a counterfeit and you still have the service contract with the company in case you need to repair it.

Deciding on which device to purchase

Dr. Saedi’s main advice: don’t rush it! A lot of the laser companies will want to push you (i.e., “this is the best deal I’m ever going to offer you”) but you should take your time and do your due diligence. For example, do multiple demos, treat the same patients again a month later, feel comfortable with the procedure, and see results for yourself. Other recommendations from Dr. Saedi include:

      • Review the safety and efficacy data on the devices you are considering purchasing.
      • Speak with colleagues about:
        • The nuances of the device
        • Patient experiences
        • Real-life complications
      • Favor devices that have a good track record. The newest device might not be the best device.
        • Be wary of lofty promises of safety and efficacy of devices sold to you by companies.

First 5 devices to consider when starting out

Dr. Saedi typically recommends starting with these 5 devices:

      • Vascular device w/ IPL platform
      • Pigment device- QS or PICO
      • Hair Removal
      • Skin Resurfacing
      • Body contouring/skin tightening

If you can cover treatments for vascular, pigment, and texture concerns, you can treat about 90% of your aesthetic patients who come through the door!

A lot of people end up purchasing a multifunction device (one platform with attachable handpieces that allows you to address multiple concerns) as with vascular lasers. When asked about single-function vs multifunction devices, Dr. Saedi finds multifunction devices to be great but you have to be careful about being bottlenecked in one room. With that being said, if you are starting out and can only afford to acquire one piece, then it’s good to be able to offer many different treatments right off the bat.

      • Examples of single-function devices:
        • PDL – vascular lesions
        • Q-switched nd:YAG- pigmented lesions, tattoos
        • Possibly more effective, targeted treatments.
        • Need more space and more capital.
      • Examples of multi-purpose devices:
        • IPL- Vascular, pigment, hair
        • Good for a small practice but can create a bottleneck in the room.
        • Make sure it is good at all the functions that it claims.

Final Thoughts from Dr. Saedi

To close her session, Dr. Saedi recapped her main advice: look into what your patient demand is. What is trending on social media or people are talking about might not be what best suits your patients’ needs. You have to be comfortable doing those procedures. Take a close look at the data, speak with your colleagues about the nuances of the device you are considering, patient experiences, and real-life complications. 

This information was presented by Dr. Nazanin Saedi at the 2021 ODAC Virtual Conference held on January 14-17, 2021. The above highlights from her lecture were written and compiled by Dr. Sang Kim.

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