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Inside the Business of Body Shaping

Article-Inside the Business of Body Shaping

Though surgical options remain a gold standard in many aesthetic cases, the energy-based body shaping industry has experienced substantial growth in recent years. The latest generation of less invasive technologies and products has shown considerable improvement over past iterations, with improved patient safety, efficacious outcomes, reduced treatment and recovery time, as well as less pain. Minimally or non-invasive contouring treatments attract patients that are fearful of surgery, or have tried, but failed to remove unwanted localized fat. In addition, these procedures appeal to both core and non-core physicians.

According to the recently published Global Aesthetic Market Study XV from Medical Insight, Inc. (Irvine, Calif.), the worldwide market for all body shaping, skin tightening and cellulite reduction equipment and procedures continues to rise. Through 2021 global sales of platforms, excluding disposables, will increase by 12.1% per year, on average and sales of disposables are expected to grow by a strong 19.5% per year as procedure volume expands.

While the overall market is enjoying strong growth, the economics of adding and maintaining energy-based body shaping devices in practice can be a challenge for physicians. Many physicians find themselves overwhelmed by the necessity to first understand the technologies involved – from lasers and radiofrequency (RF) to ultrasound-based solutions and radial shockwaves – and then the business of adopting these systems into their practices, including making a quality purchase or lease, ease of transition to a new device, and other issues that are not taught in medical school.

According to Gordon H. Sasaki, M.D., F.A.C.S., a plastic surgeon and researcher in Pasadena, Calif., “quick fix elective non-surgical and minimally invasive procedures meet the needs of a very educated, active population. “These patients frequently require procedures that are natural looking at an acceptable price with minimal downtime,” he pointed out.

“Treatments have become more comfortable over time and most energy-based devices now have improved patient safety features,” stated J.D. McCoy, N.M.D., an aesthetic practitioner in Gilbert, Ariz. “More importantly, ease of use of these devices has improved. The reality is that most of these treatments should be delegated when possible. This means we want the procedures to be easily reproducible, so that when you transfer responsibility the operator and patient can expect consistent results.”

Like many surgeons looking to differentiate their practice with energy-based body contouring, Diane Duncan, M.D., F.A.C.S., a plastic and reconstructive surgeon in Fort Collins, Colo., wanted to invest in something that could shrink soft tissue and skin non-surgically. “In particular, a non-invasive system that actually works without burning a hole in the practice’s wallet,” she said.

After much research she incorporated two systems into her practice. The first was BodyTite from Inmode (Richmond Hill, Ontario Canada), which utilizes patented radiofrequency (RF)-assisted liposuction (RFAL™) technology for body contouring and skin contraction. The second is the Thermi® platform from Thermi, an Almirall Company (Irving, Texas), which delivers temperature controlled RF-based energy for both microsurgical and non-surgical aesthetic applications in soft tissue and nerves. “With these two systems I can offer my patients really outstanding results,” she noted.

When first starting out in aesthetics, many physicians adopt systems that are designed primarily for facial work, Dr. McCoy noted, “But then they quickly realize that patients not only want to treat their face, but almost every single person has something on their body that they’d like to improve. And they demand relatively low discomfort so they can get back to their daily life and activities soon after they engage in treatment.”

Physicians would be wise to employ a checklist of concerns and questions when determining the best system for their practice, stated Jay A. Shorr, B.A., M.B.M.-C., founder of Shorr Solutions, a Florida-based medical practice consulting firm.

“For instance, decide whom on the staff can operate the device and what are the stated rules regarding levels of authority,” Mr. Shorr elaborated. “With a specific device, how long do the results last versus other modalities? What type of support will you get from the manufacturer, in terms of marketing support and warranty? Is there another upgrade right around the corner and is that included with a maintenance plan?”


Dr. Sasaki encourages physician buyers to adopt a business-centric methodology when integrating energy-based body contouring devices into their practice in order make a good buying decision. “From a device standpoint I think the manufacturer should be willing to show a clinically proven experience level with clear safety profiles, reasonable comfort during treatment, acceptable downtime and of course high patient satisfaction,” he explained. “If possible, it should be a brand name backed by evidence-based research.”

“Each of my current devices has to earn the title of working core system,” Dr. Sasaki continued. “They are not to be parked in the corner and they should be used on a daily basis either in combination with other modalities or alone to boost outcomes and meet patient expectations.”

The devil is in the details when it comes to a device’s origin and technical sophistication, Mr. Shorr added. “Is it FDA approved or is it manufactured internationally? What are the applications it can perform? Does it also treat other indications? If it is a multifunctional platform and one portion breaks down is the rest of the system inoperable? Can you purchase individual modalities or must you purchase them all? Do the product’s consumables time out or can they be used on multiple treatments with the same patient?”

While single modality devices are still extant and worthwhile, turnkey multi-technology platforms and other devices that add value to body shaping procedures are becoming very important additions to aesthetic practices, Dr. Sasaki noted, adding that he employs the Z Wave from Zimmer MedizinSystems (Irvine, Calif.), as an adjunct to both surgical and non-surgical procedures. The Z Wave uses high energy, non-invasive radial pulse therapy to help enhance results of other contouring treatments, such as Cryolipolysis.

“With multifunctional systems you have to be able to use them as a standalone treatment or with other devices to obtain the best results,” Dr. Sasaki reported. “As always, patient selection is critical to success, but the device also has to first fit into your current patient demographic.”

Fotona (based in the U.S. and Europe), has recently introduced a multifunctional body shaping system called TightSculpting™. This dual-wavelength, non-invasive laser treatment combines hyperthermic adipocyte destruction and collagen remodeling in a fast and effective alternative to laser lipolysis, with no consumables or downtime.

For Doohi Lee, M.D., a cosmetic surgeon in Plano, Texas, TightScupting represents a significant technology advancement. “This phenomenal implementation of the physics of laser science delivers energy to tissues very effectively, and with good results. It utilizes Nd:YAG and Erbium energies in a non-ablative, non-surgical way to eliminate undesired areas of fat while tightening the skin,” he reported.

While choosing the right technology has its challenges, managing patient expectations when using those technologies is also a top priority. Some practitioners have adopted new approaches to help patients remember appointments and improve compliance issues.

“If a client doesn’t cooperate with their own treatment plan then it will not work. It is a waste of everyone’s time and their money,” stated Suneel Chilukuri, M.D., a cosmetic and dermatologic surgeon in Houston, Texas. “So, we have changed our approach. I have my body shaping patients keep a diet and exercise log that we can track together on an app.”


In addition, according to Dr. Chilukuri, multi-modality procedures are, “A home run for patients. The fact that we create combination protocols makes us unique. When our patients ask, ‘can you do this or that treatment,’ we say yes, we do it all. We do not have just one, but rather six or seven devices that can contour and be utilized with supporting products to rein in post-procedure discomfort and other concerns that arise. When choosing these combinations, it is extremely important to consider what devices and modalities will work together synergistically.”

In recent years, the intelligent use of these types of combination therapies has increased the popularity of device-based body shaping procedures, Dr. Chilukuri added. “People come through the door and ask for a treatment or device brand by name. They are that tuned in,” he expressed. “Generation X and Baby Boomers are approaching the stage where they notice skin laxity and fat on the top of the thigh or on the knee, so we are using RF or ultrasound contouring combined with acoustic wave devices, collagen stimulatory systems and normal saline to enhance results.”

Along with patient requests there are cost concerns as well. The purchase or lease of a new aesthetic system is a significant investment for any practitioner, emphasized Jared E. Mallalieu, D.O., a cosmetic surgeon in Severna Park, Md. “When you start contemplating spending as much as $150,000 for a single device, it really comes down to the brand. It should have some name recognition online, for instance. I’ve had patients tell me they searched online for the brand name to help identify the appropriate procedure for them. A product that also promotes my practice helps drive business. This is beneficial because six or seven years later, long after the device has been paid off, it can still generate the same amount of income for us. That scenario is really fantastic.”

Dr. Mallalieu offers the ProLipo PLUS from Sciton, Inc. (Palo Alto, Calif.). He based his product choice equally upon the firm’s high touch approach and the system’s technology. The ProLipo PLUS features 1064 nm and 1319 nm laser wavelengths in one system and delivers up to 40 Watts of power, for immediately visible body sculpting results and firmer skin. “This was a fantastic buy – a ‘Cadillac’ type of product,” he said. “Prior to obtaining this system we did not really do any liposuction treatments at all. In the first 18 months of use we have done over 175 cases of laser lipo. In addition, the company does not nickel and dime me when it comes to disposables. That’s another reason why I went with Sciton.”

Minimally and non-invasive body shaping procedures open up a lot of options for those that don’t want surgery or in those cases when it is too early for surgery, stated Amber Bocknek, M.D., an aesthetic physician in Newmarket, Ontario, Canada. “Throughout my career I’ve used systems that gave me less than satisfactory results, so I started searching for something that was high performance and actually worked,” she recounted. She settled on the vShape Ultra from Alma Lasers, Inc. (Buffalo Grove, Ill.), an advanced multiplatform device that integrates various technologies, including ultrasound, focused RF and ablative RF microneedling. In addition, it requires no disposables. “vShape Ultra really helps me deliver on patient satisfaction, and because I don’t have the consumables cost built into my price point, my overall course of treatment for patients is considerably less expensive than some other body contouring devices. Therefore my patients are not driven by cost factors. In the end, I just have happier patients,” she said.

“Consumables can be expensive and their cost is important to your profit and loss statement,” Dr. Sasaki noted. “Manufacturers create an annuity income with such things as disposables, maintenance contracts and warranty fees because that is where they make their profit.”

Along these lines, Dr. Duncan says a fair number of physicians have made device purchases based on more of a clinical view than an economic one. “I have two laser-based systems that offer patients outstanding results, but may not have been the best investment,” she shared. “Consider the results achieved versus the cost of a yearly maintenance agreement for such devices, which may run you $14,000 per year. This is not affordable.


Even when a new device has a solid background and works to differentiate a practice and open it up to potential patients, return on investment (ROI) can be difficult to assess, stated Dr. McCoy, who also employs the Z Wave. “Z Wave helps to improve patient outcomes and supports other modalities. It definitely helps improve the comfort of multiple treatments that I offer,” he said. “With the value it adds I’ve been able to charge more and sell more procedures. While there may not be a direct ROI from this treatment, it is something that differentiates me because not everybody is doing it. ROI can also come from the ability to differentiate yourself as a leader in the industry.”

Surprisingly, some physicians still approach energy-based systems as a money losing proposition. “I heard one of the most knowledgeable plastic surgeons in the business give a talk on how device purchases are unwise,” Dr. Duncan revealed. “The belief is that by the time you have finished paying the system off you haven’t made any money, the device is outdated, and you actually paid extra for the privilege of getting stuck with a dust gathering, space consuming piece of equipment.”

However, as Dr. McCoy conveyed, device manufacturers have done a good job of presenting potential buyers with quality purchase or lease deals. “There were horror stories in the past, but this has actually improved a lot in recent years,” he said. “Companies have started to realize that medical aesthetics is a very small community and unethical vendors simply don’t last.”

One of the most established brands in energy-based body shaping is the VASERlipo® System from Solta Medical, a division of Valeant Pharmaceuticals North America, LLC (Hayward, Calif.), which uses minimally invasive ultrasound technology for precision body contouring. According to John A. Millard, M.D., F.A.C.S., a plastic surgeon in Denver, Colo., this system enables physicians to sculpt both the deep and superficial fatty layers. “The VASER works very effectively in the superficial fatty layer, enabling three-dimensional shaping of this layer and substantial skin tightening,” he noted. “For example, using my techniques I was able to transform a female patient from a size 14 to a size 6. You can also remove around twice as much adipose tissue per cubic centimeter, and that fat is viable for grafting.”

Tahl N. Humes, D.O., an aesthetic practitioner in Denver, Colo., sought a body shaping device that would provide consistent, effective results and she chose truSculpt® 3D from Cutera, Inc. (Brisbane, Calif.), which delivers controlled monopolar RF technology at 2 MHz to uniformly heat the subcutaneous adipose tissue. “Our patients can tolerate heat really well and truSculpt 3D provides an incredibly comfortable treatment for multiple body areas that is quick and reproducible.”

Having an energy-based device that can address several body areas was a requirement for Dr. Chilukuri. “I was on the hunt for a more efficient body shaping system that produced consistent results,” he said. “I investigated many new technologies and energy types, and decided to go with Vanquish ME from BTL Aesthetics (Boston, Mass.). It was paid off in less than five months and has been steadily profitable ever since. We are achieving some stellar results. I use it in combination with other modalities on the face and neck, as well as the body. It works well for debulking and is a great option to have for anyone with a larger BMI.”

Ultimately, patients have the last word on whether or not an energy-based body shaping device has been successful, Dr. Sasaki noted. “Patient satisfaction is usually very high with our body shaping devices, but they have to be complemented not only by other devices, but by physician-dispensed topicals and if need be, surgery. For plastic surgeons, like myself, that’s our core.”

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