CONSIDER THIS BEFORE YOU BUY A NEW DEVICE

Anne Chapas, MD is Founder and Medical Director of Union Square Laser Dermatology in New York City. She is a Clinical Instructor of Dermatology at the Mount Sinai Medical Center.

Lasers and energy-based devices represent one of the most substantial investments an aesthetic practice can make. Selection of the “right” system can be daunting, even for those with experience. Modern Aesthetics^® magazine spoke with dermatologist Anne Chapas, MD, who learned much about buying lasers when she opened a brand new practice three years ago. Dr. Chapas has presented on the topic of laser purchasing and shares her tips ahead.

WITH LASER AND ENERGY-BASED DEVICES AVAILABLE FOR SO MANY INDICATIONS, HOW SHOULD A PRACTICE NARROW DOWN THE FIELD?

Dr. Chapas: You really need to know your patient population. What works well for a dermatology based laser practice may not be the best fit for a plastic surgeon practice or other types of practices.

Dermatology practices pretty consistently see benign skin lesions, blood vessels, photodamage, wrinkles, so systems designed to target these generally are a good fit.

Other types of practices, I think it would depend on the types of patients that you're seeing.

ONCE YOU IDENTIFY A CATEGORY OF DEVICE, WHAT ARE THE BEST RESOURCES FOR LEARNING MORE?

Dr. Chapas: If you're new to the field, the best option is to attend one of the major conferences where many devices are being exhibited. The American Society for Laser Medicine and Surgery, the Society of Plastic Surgeons, the American Academy of Dermatology and meetings like these are good opportunities to meet with all of the major companies. It's one good way to see everything all in one place, and you can start to focus from there.

Once you have an idea of the type of device that your would like to purchase, look closely at maybe three devices in a category. Contact the companies directly to identify a sales representative in your area.. The reps are happy to talk to you, come into your office, and maybe even demonstrate the device for you.

In addition, I think a highly important thing to do at this point is to talk to a trusted peer. Ask that peer how long they've had the device. Do they have a relationship with the company? Did they pay for the device? How long did it take them to pay it off? Do they own other devices in that category, and which one do they use most?

It's great to hear what a company has to say, but it's even more valuable to hear what is actually used in a practice and how successful it's been in someone's practice.

ARE MULTI-USE DEVICES A GOOD OPTION?

Dr. Chapas: Every practice is unique. There are definitely pluses and minuses to going with something that is one box with multiple handpieces that keep changing on and off. I don't know one super device yet that does everything you want to do in your practice. I also think sometimes that “all in one” approach can be limiting if you have only one box and multiple handpieces; if that box is being used then no other patients can be treated at that time.

WHAT ABOUT USED SYSTEMS AND ALTERNATIVE DISTRIBUTORS?

Dr. Chapas: The one big thing I would stress that is becoming quite prevalent in the US market that we are starting to see a lot of complications from is the use of devices that are not FDA cleared. Do not buy a device that is not from a major manufacturer.

We're seeing a lot of counterfeit devices causing some serious injuries in the patient population. I receive an email every single day saying, “If you like X device, you'll like our imitation X device from China!” I think we're going to start seeing more and more problems from these devices.

All of the reputable laser companies that have FDA clearance for their devices have gone through rigorous application and testing processes of their devices. They have strong sales forces throughout the country that would be happy to meet with any practice, so there is no reason to go through unknown distributors.

I would buy a secondhand device only if I were very savvy. I still use some older devices that I still think are tried and true. But keep in mind that for the most part, these second-hand devices are obsolete for a reason. Maybe they are not powerful enough, later generations have become more comfortable, etc.

WHAT ARE SOME PHYSICAL REQUIREMENTS TO CONSIDER?

Dr. Chapas: I think that people may not ask enough questions about physical requirements needed for the new device that they are considering. Certain devices in my practice run on 220v electrical lines. You have find out and to make sure that you have installed 220v electrical lines before you purchase this type of device. Some systems are significant heat generators, so you have to make sure you have enough air conditioning/cooling in your practice. There are many compact systems, but some have a fairly large footprint, so you need to assess your available space.

WHAT ARE LONG-TERM COSTS TO CONSIDER?

Dr. Chapas: I think you have to look at each device's fixed and variable costs within your business model. The fixed cost is the purchase price of the device, while variable costs could include:

• Tips
• Cryogen
• Handpieces
• Windows
• Dye kits
• Service contracts—10% of the system cost per year is typical.

When you figure out your ROI for a device, you need to figure your fixed and variable costs.

Some people consider consumables to be beneficial. If the laser company is generating revenue every time you use the laser, then the laser company becomes invested in promoting your practice and supporting the successful integration of that system.

You really need to look at your practice very carefully. Do the homework yourself and don't trust what a company is going to tell you as far as of how quickly you are going to be able make an ROI.

Look at your practice: How many cases your practice will generate at your current state; the actual cost of the device and the consumbles; the contract cost; the cost of another physician in the practice—their salary costs. Then you can really figure out your return on investment.

WHAT ABOUT THE OPTION TO PURCHASE VERSUS LEASING?

Dr. Chapas: In my experience, leasing has never been a good option. The leases are very convoluted making it difficult to identify the actual interest rate to be charged. They may tell you an average of what you'll be paying, but they are variable over the term of the lease, and the interest rates tend to be higher than the current lending rate what you'd pay on your mortgage or a car.

Leases can potentially lock you in; it may be difficult to get out of the lease once you are out the current cash flow situation and can afford to buy the device.