Editor's Message: Only as Good as the Operator

In the early days of modern laser technology, practices were divided among the “device guys” and everyone else. Devices often had complicated parameters and post-treatment care. Patients were referred to colleagues who had the specific lasers and experience to treat vascular and pigmented lesions and resurfacing, then those physicians referred the patient back for everything else. Over the last two decades, however, there has been an explosion in the number of available devices for aesthetic practice. With that, both new opportunities and stressors have emerged for core cosmetic physicians.

Devices in many categories—lasers, light sources, ultrasound, radiofrequency, and combinations of those—are now user-friendlier and widely available at both physician offices and non-physician spas. Patients hear about them from the media and ask for them by name. Unfortunately, the results don't always keep up with the hype. Physicians are often in an unfavorable position between wanting to be the first to offer a new procedure versus waiting until the technology and treatment protocols are optimized. Additionally, device ownership encompasses a vast number of responsibilities and considerations that physicians must be prepared to balance. These include cost, staffing, setting realistic patient expectations, and, above all, knowing when it is time to jump in to a new technology or treatment indication.

This edition of Modern Aesthetics® contains a variety of insights about both the investment in and use of aesthetics devices in practice. In this month's Editorial Board Forum (on page 38), expert physicians from the four core cosmetic specialties with practices across the device spectrum offer their own “Dos” and “Don'ts” gleaned from their wins and misses with technology.

No one among us makes the perfect decision every time. For every new device that has paid for itself in months, you will find another in the same office that has become a very expensive doorstop. Peer reviewed and throwaway journals contain lists of machines available in every category. There are KOLs at meetings and in the media raving about one choice over the other. As we sort through the informational noise, it is especially important to think about technology as we think about any other surgical or cosmetic procedure or product we're considering providing and ask ourselves: How will it help us to deliver optimal results to our patients?

The best use of any tool—be it a needle, blade, or laser—is one that's ideally suited to the physician's interests, office capacity, staff ability, and patients' desires. And always remember that, ultimately, it is the physician that makes the technology succeed and not the other way around. After all, it isn't the paint or paintbrush that determine the quality of the painting: it is the painter.

Steven Dayan, MD, FACS, and Heidi Waldorf, MD, FAAD