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Attract More Patients and Keep Them Coming Back

Article-Attract More Patients and Keep Them Coming Back

Sponsored By CAREstream; While the demand for aesthetic treatments has expanded thanks in part to non-invasive treatments, social media and a higher acceptance of cosmetic procedures, barriers for patients seeking treatments remain steady.

Sponsored By CAREstream; 

While the demand for aesthetic treatments has expanded thanks in part to non-invasive treatments, social media and a higher acceptance of cosmetic procedures, barriers for patients seeking treatments remain steady. This includes fear of pain, needle phobia and poor outcomes, while there is also concern about the safety of treatments that require oral analgesics.


Many aesthetic thought leaders agree that patient retention is key to expanding an aesthetic practice. There are three significant factors to attracting and retaining more patients: offering quality treatments with measurable outcomes, managing pain and anxiety and adopting an advanced practice management system.

According to plastic surgeon Stephen Mulholland, MD, (London, England), founder of a cloud-based practice management system, BoomerangFX (Mississauga, Ontario, Canada), introduction of Millennials and Generation X, in addition to the Baby Boomer generation, has created a large and potentially fertile market of 160-180 million potential patients, in a recession reliant industry. “Retention management is the most overlooked component of a private, non-managed care practice,” he began. “In the post-digital world where 82% of all aesthetic procedures are non-invasive, it is strategically important to build a maintenance component to your business and then get the patients back in.

“ embodies this concept, enabling every private pay practice to establish services, from skincare, to laser, to radiofrequency (RF) and injectables,” Dr. Mulholland continued. “This includes a built-in, software identified and amplified retention management program that is part of maintaining and extending a patient’s good result and ‘protecting the investment’. By employing a ‘BoomerangFX strategy’, a practice can increase sales and profitability by 25% to 40% without a single new lead or patient in the practice, by simply ensuring all the treatments and patients you have keep coming back.


As part of his practice management strategy, Dr. Mulholland realized that fear, anxiety, discomfort and pain can be conversion killers and sought a way to help his patients get the treatments they wanted with less stress, so he decided to introduce Pro-Nox™ into his practice. Pro-Nox, distributed by CAREstream America (Lake Mary, Fla.), is an oxygen and nitrous oxide delivery system that can improve patient comfort in numerous aesthetic treatments such as RF microneedling, ablative and non-ablative laser treatments, focused ultrasound, injections and platelet-rich plasma (PRP) treatments. With quick onset and a short duration of effect, patients can incorporate this pain relief tool for the duration of their treatment to improve comfort and satisfaction.

“Almost six years ago, I introduced Pro-Nox into my practice. It is a patient-administered inhalational analgesic device and was one of the most important practice conversion strategies I have invested in,” Dr. Mulholland shared. “This device provides a legal, easy to deploy and affordable agent that quickly produces a surge of serotonin and dopamine in the patient’s brain, which are the neurotransmitters of wellbeing. Deployed a couple of minutes prior to a treatment, Pro-Nox creates a sense of euphoria, reduces anxiety and while not eliminating pain, modulates its perception, ensuring that any treatment perceived as painful or uncomfortable, is less stressful and more enjoyable.”

Mona Greene, MSN, NP, clinical director for Pro-Nox Aesthetics, explained that nitrous oxide is an excellent anxiolytic and increases the neural transmitters of wellbeing like dopamine, and norepinephrine which inhibits pain signaling. “The 50/50 fixed mixture of nitrous oxide and oxygen has been used in birthing centers for decades worldwide and yields a high safety profile,” she reported.

“Pro-Nox was FDA cleared in 2012 and has been used extensively in aesthetics for more than six years,” continued Ms. Greene. “This past month marks six years that Pro-Nox was widely launched into aesthetics. With over 7,000 practices and more than 1 million patients safely treated, we now have the most effective way to manage pain, discomfort and anxiety while being able to deliver an effective treatment. As a nurse practitioner, my primary objective is safety first and Pro-Nox has an excellent safety profile. In fact, 99% of the Pro-Nox practices we surveyed believe it is safe and effective.”1

Ms. Greene noted that what sets Pro-Nox apart from other pain-relieving strategies is a rapid onset of action (within a minute), it is self-administered (patient controls their level of comfort) and patients are able drive themselves home soon after treatment. It eliminates the need for opioid medications for most aesthetic procedures.

“I first started using Pro-Nox for the most painful procedures in the practice but expanded to offer it on any treatment that is perceived as uncomfortable to eliminate any barrier to conversion, such as discomfort and anxiety, is removed through the use of nitrous oxide,” reported Dr. Mulholland. “Intense pulsed light (IPL) photofacials, laser hair removal, neurotoxins, dermal fillers and fractional bipolar RF can all benefit from Pro-Nox. Not all patients request it for all procedures, but I ensure all patients try it at least once for painful needle and laser treatments. Patients are much more apt to book their subsequent treatments and convert to other services and act as ambassadors, referral sources and post online if they have used Pro-Nox.”


Dr. Mulholland shared that for the past 25 years, his practice has been competing for market share in the third largest city in North America (Toronto) with a population of nearly 7 million people. The advent of paid digital search and artificial intelligence- (AI-) powered lead generation has witnessed a decrease in the cost per lead (CPL) from $250 - $500 in the mid-1990s using traditional print and broadcast, to $50 - $100 using modern, cultivated paid search. He explained that a wellrun boomerang practice will be able to convert 70% to 80% of these non-invasive leads to a consultation and 80% of those consultations to treatments, and retention remains a necessity.

“A ‘Find them, wow them and grow them’ mantra and ‘boomerang way’ means you optimize lead, consult and treatment conversion and then grow retention, cross merchandising and ambassadorship,” concluded Dr. Mulholland. “Pro-Nox is an important conversion strategy that is part of a profitable and reproducible business model.”


1. Wang JV, Munavalli GS, Pozner J, Geronemus RG. Safety and Utility of a Novel Nitrous Oxide Delivery System in Cosmetic Surgery: A National Survey of Physician Practices. Dermatol Surg. 2021 Oct 1;47(10):1418-1419. doi: 10.1097/ DSS.0000000000003168. PMID: 34313636.

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