It may be tempting to buy older medical laser equipment because of the great price, however you must be extremely cautious about this.  The newer equipment on the market has become more user-friendly and safer to use.  Using older technology can be much more “expertise” driven and in the wrong hands, can have disastrous results.  Some of the problems with older technology is inadequate cooling on the skin, a lack of ongoing calibration and maintenance, and a poor user-friendly interface that helps ensure the operator provides a safe treatment.  While newer equipment can never replace someone who has been properly trained in the safe user of lasers, it goes a long way to help prevent adverse reactions from occurring in the first place.

Ideally, you want to buy a laser that has seen little use that is no greater than 3 or 4 years old.  If you go too far beyond this point, you can run into a lack of third party support for the laser and a lack of people who can repair it or find replacement parts.  It can also be too outdated and more dangerous to use.  That said, some technology has not changed dramatically over the past 8 or 9 years and it may still be worth a look, laser hair removal being a prime example  If you find a laser with a low pulse count that is an older model unit (Candela Gentlelase for example), find out if the same unit is still manufactured today.  If it is, then obsolescence may not be a problem and you can potentially get a really great deal on a very effective and reliable laser.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

At the beginning of the laser-buying process, many people already know the laser they want. But it’s a good idea to stop right now and test your decision with this question: Will this laser fit into my practice and my monthly budget?  Buying a laser at the right price is an important first step.  Developing a realistic pro forma of the revenue you anticipate generating from this laser is critical.  The key word here being realistic.  It is important to be sure your revenue numbers are very conservative so you won’t have problems getting a solid ROI on your new device.  If your revenue numbers can easily support the price you are paying for this unit, then it may be the right laser and the right price. 

• Patient Population.  What kind of population are you serving? gender, age range, ethnic types (Fitzpatrick Skin Types I thru VI), your surrounding competition?  There is no true all-purpose laser platform.  Make your determination FIRST based on your practice profile, then decide on specific platforms.  It is imperative that you objectively identify your market first before making decision on laser machines. This will minimize risks of side effects or poor clinical outcomes or buying the wrong laser platform for your targeted client base.
• Wavelength.  If you have a patient population of darker skin types and you wish to do laser hair removal, you will need to be sure to have a laser that can treat darker skin, such as a 1064 Nd Yag.  On the same token, if you have a patient population of lighter skin types you want a hair removal laser that best treats this patient base, such as an Alexandrite.  If you have a mix of all skin types, then perhaps a diode laser with a long pulse width would be the best fit for you.
• Profitability.  If you want your practice to be profitable, you must focus on HIGH DOLLAR / HIGH MARGIN treatments.  In general, the most worthwhile investment to focus on is skin resurfacing, skin tightening and body shaping (laser lipolysis, Radio Frequency).  People are willing to spend big dollars to rejuvenate and tighten their face and sculpt their body.  Selling larger packages typically means combination therapy which results in happier clients.  It is important that you understand that your goal of increased revenue is aligned with the client wanting the best results possible  Small packages or single treatments typically do not yield good results and the client walks away dissatisfied – never to return!
• Spot size.   The spot size of a laser determines how much skin area can be covered per laser pulse.  Lasers with larger spot sizes can cover more area much more quickly. For example, a laser hair removal treatment of the back or full legs could take as long as 2 hours with older lasers. Today, these areas can be completely treated in less than 20 minutes.  The spot size not only determines the speed and comfort of the treatment, but the efficacy as well.
• Hertz.  The hertz, or pulses per second, tells you how fast the laser emits each pulse.  Some lasers can go as fast as 3 pulses per second, which allows you to cover more surface area faster.  This is an important feature, especially for laser hair removal lasers.
• Consumables.  Some aesthetic devices are very expensive to operate, however it may still be worth your while IF you are able to charge higher prices with these same medical devices.  Some examples of consumables include:  Single use treatment tips, Cryogen Canisters, Coupling Fluid, Lightguides, Handpieces with a certain pulse life, Filters, Fibers, etc.  You need to factor in the cost of these consumables as you create your pro forma revenue to determine your break even costs and profits.

Understanding the Technology:  3 Key Improvements to the Face:  The 3 Ts.

To assist in determining what technology is best for which procedure, we have developed a very simple model that helps the practitioner to know what aesthetic equipment may best fit his practice and his patient population.  For simplicity’s sake, I use the following rejuvenation model called the “3 Ts”.

a)     Tone (Even Color).  The goals of even color are to eliminate pigmentation and redness (facial veins)

b)     Texture (Smooth Skin).  The goals of texture are to smooth rough skin and reduce fine lines and wrinkles

c)      Tighten (Skin Tightness & Fullness). The goal of tightening is to reduce skin laxity caused by solar elastosis, aging and other skin oxidants.

The following chart diagrams the available aesthetic procedures and their role assisting in one of the three areas of Tone, Texture or Tighten.  On a scale of 1 to 3, a 1 is considered the most effective treatment for the designated area of Tone, Texture, or Tighten while a 3 is considered the least effective treatment.  2 is considered middle of the road and not as effective.

In general, for fine wrinkle (crow’s feet) you can go with fractional skin resurfacing.  For moderate to deeper ones, this is more difficult. You can go with Portrait Rhytec, CO2, Thermage, Velashape or Alma Accent.  With Thermage or Accent, you get the added “lifting” effect which work better on the sagging wrinkles/skin as in the jowls or the droopy upper eyelids though a strong full ablative CO2 as in Luminis Active FX can do such for the eyelids.

Sometimes, wrinkles can also be corrected with fillers such as Radiesse, Perlane or Restylane as those on forehead or glabellar. Wrinkles can also result from tissue atrophy in the mid and lower face. In these instances, an AUGMENTATIVE volumizing injection (with Perlane or Radiesse) will stretch out the loose skin thus not only fading out the wrinkles and folds but also giving the lifting effects.

Be sure to ask your broker his opinion of the laser her or she recommends and why.  This will help you to determine how knowledgeable the broker is regarding the laser technology they are selling you.  Often the broker may have hands-on experience working with the laser in question.  If so, that is a plus because it shows the broker has some hands-on laser operations experience.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Here are some things you need to know about the used laser market. First of all, some of the people in it are very shady. Second, it is not standardized like the used car industry. There is not a “blue-book” value for used laser equipment. Prices and quality vary widely across the board. You usually don’t get a chance to check out (or test drive) the equipment you are purchasing. There is no lemon law with used lasers. When you buy it, it’s yours. It may be difficult getting your money back if it doesn’t perform. Most of these used dealers are not real companies. They are some guy who probably doesn’t even have the laser, but is instead brokering it. There are no real warranties with the equipment. The following are things you should look for in a laser broker and ask:

• Does the laser broker actually have the laser in his/her possession or is it a consignment sale? If it is a consignment sale, you need to do your own due diligence on what condition the laser is in because you can’t always rely on the broker giving you accurate information. Since the broker may have never actually physically seen the device, he/she may not know if there are any flaws with the device. He or she is relying solely on the doctor who owns the device to give him accurate information.
• Has this broker been certified by third parties and received a seal of reliability and ethics? Below are a few of the certifications that can be helpful in your assessment:
• Dotmed. An online website that certifies laser brokers is Dotmed (found on the internet http://www.Dotmed.com). Find out if your laser broker is Dotmed Certified.
• Ebay.  Every Ebay seller should have a seller’s rating. Find out if your broker has sold on the internet and what his satisfaction rating is. You want to see as close to 100% satisfaction as possible.

These certifications mean a lot to laser dealers and brokers because it validates their good reputation. Brokers and dealers who plan on selling medical lasers for many years to come do not want anything to happen to these ratings because they realize how important they are in selling equipment.

• Has the broker had the equipment inspected by someone qualified to repair the laser prior to shipping? Even used lasers cost a lot of money, so it behooves you to make sure the laser that you’re buying has been properly inspected prior to purchasing. This should be done by a technician who knows the laser and should be done before you put any money down. Would you buy a used car from a fly by night dealer without having your mechanic look at it? Once it’s been purchased, all bets are off. Apply leverage to the broker when you have leverage, and that is prior to purchasing.

Many brokers tout that their laser equipment has been “refurbished.” This statement means absolutely nothing if the laser broker cannot provide documentation of the laser’s refurbishment. If they claim it has been refurbished, they should be able to send you a checklist of items that have been done to the laser in a matter of minutes via email or fax. If they cannot provide this to you in relatively short order, then nothing has been truly done to this unit.

If you have any doubt as to the laser’s condition, you can also ask the broker to shoot a video of the laser in operation, showing the following:

1. The laser being fired
2. The pulse count on the screen
3. The user adjusting the treatment parameters on the screen
4. The serial number of the unit.
5. Any material defects the laser may have that need to be disclosed

The bottom line is this: You want to make sure the laser is in good, operating condition. You need to make sure it is actually functioning. Shooting video these days is extremely easy. You can buy a Flip HD video camcorder for less than $200 and shoot high resolution video that can be uploaded directly to YouTube in a matter of minutes. Don’t let this process intimidate you. You are about to make a very large investment. Asking these items of your broker shouldn’t be seen as excessive.

4.   The Importance of a Laser Inspection Checklist

How do you know if a laser has been inspected or “refurbished”? Ask for a laser inspection checklist that has been completed by someone qualified to perform the inspection. Below is a basic laser checklist THAT SHOULD BE PERFORMED ON ANY LASER PRIOR TO BEING SOLD TO ANOTHER PARTY:

Laser Inspection and Maintenance Checklist

Inspection / Maintenance Item Date Completed Tech Initials
1. Check coolant level and add deionized water.
2. Inspect electrical connections.
3. Perform power meter calibration check.
4. If more than 250,000 shots replace deionizer cartridge and DI water.
5. Inspect and clean internal optics (if applicable)
6. Replace Xenon flash lamp if power is low and more 250,000 shots.
7. Inspect footswitch for proper operation.
8. Verify laser has no leaks after replacing any filters or connections.
9. Check High Voltage Power Supply.
10. Verify operation at all power settings.
Signed:_____________________________________Date:_________________________
Laser Repair Company:____________________________ Phone:___________________

In most cases, the inspection checklist will not have been performed prior to the broker listing the item, however you should make it a condition of the sale that the laser be properly inspected. If you do not require this, you will be buying at your own risk.

• Can the broker provide you with a service report on the laser while it was under the manufacturers warranty?  In addition to the laser inspection checklist, you should also request any and all laser service reports that documents any maintenance that has been done on the laser since it was purchased new.  Sometimes the selling doctor may no longer have a record of this, however this should also be available from the laser manufacturer.  Manufacturers have a responsibility to document all repair and maintenance work that has been done to the laser as part of any warranty they have provided for the laser when it was purchased new.

Brokers can be hesitant to provide you with a serial number of the laser because they do not own the laser.  With a serial number you can call the manufacturer and find out where the laser is and sometimes who actually owns the laser.  This makes brokers nervous because it means that you can potentially go around them and buy directly from the owner of the laser unit.  Such behavior is completely unethical, however it does sometimes happen which is why laser brokers are very careful about providing such information to you.

• Can the broker provide you with at least 5 references within the past 3 months of doctors he has sold to?  Not every transaction will always run smoothly every time with a broker, however does the broker adjust to problems and ensure that things get back on track to keep the buyer happy?  Calling references of recent transactions will allow you to find out from buyer’s their level of satisfaction with the broker and whether they would do business with him or her again.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Before you buy a used medical laser, it is critical that you identify third party companies who can repair it. You can’t always rely on the manufacturer to support your used laser. As was already mentioned, manufacturers will often turn their back on any doctor who has not purchased a new laser directly from them.

It is important that you find out from your broker who they use to repair the lasers they are selling you. You need to ask them which laser repair companies are “the best” third party repair companies. You want to get names and phone numbers of specific people who have experience repairing the lasers you wish to purchase.

After 90 days of warranty from the broker who sold you the laser, you will be “on your own” and you need to make sure you can continue to get the support you need for your used laser. You need to conduct your own independent research on the internet (I prefer using Google) to find out the following information from third party repair companies:

1. Identify at least 3 or 4 companies who specialize in repairing the used laser you wish to purchase
2. Ask them to provide you with at least 5 or 6 references of people they have recently serviced
3. Find out whether they have laser repair techs who have been Manufacturer-Certified to work on your used laser
4. Find out if they can obtain parts for your laser. Many manufacturers make it very hard for anyone outside their network to obtain parts such as laser fibers and dye kits. Don’t forget that laser and IPL parts are typically unique to one particular device. Some laser companies won’t even warranty the laser for you if it is not purchased directly from them.
5. Find out whether they have the diagnostic software from the manufacturer to trouble shoot problems with the device
6. Ask them to tell you the most common repairs the device needs and a ball park cost to repair the most common problems
7. Whether the company can offer you a third party extended warranty on the laser, how much it costs, and what all it covers.

You need to do this footwork BEFORE you buy. After you buy it can be too late and you may be taking too large of a risk.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Laser brokers typically give you a 90 Day Warranty when you buy a used laser, but they are really just gambling that it won’t break down during those 90 days. If it does, they have to get someone to service the laser, get parts etc. so be ready to be down for awhile if this happens. In addition, the cost of the repair is coming out of their gross profit from the sale, so they may wish to drag their feet to avoid paying these costs. A good broker will deal with the issue head-on and get it taken care of immediately. Every day that your laser is not functioning is a day you are losing money and the broker should and must respond QUICKLY to this emergency.

Paying top dollar for new equipment allows peace of mind with warranty protection, but it comes at a very high cost. While it is true that most used laser equipment is no longer under a manufacturer’s warranty, research has shown that you are almost ALWAYS better off buying used equipment and paying out of pocket for maintenance and repairs versus buying new and having it covered under warranty. You are simply paying too high of a premium for the luxury of buying new. If peace of mind is the issue, then buy a back-up piece of equipment at a 70% discount that you can rely on when your primary equipment goes down. The reality is you will still be paying less than buying the brand new piece of equipment or a manufacturer’s warranty.

The truth about buying manufacturer warranties is this: They are extremely expensive and are written HEAVILY in the favor of the manufacturer. If nothing goes wrong with your laser device while under warranty, you normally have nothing to show for the money you have expended. We call this “vaporware” because the only thing you bought was a little peace of mind for a short period of time. This money can never be retrieved and is forever lost. Instead of buying “vaporware,” how about buying a back-up piece of hardware? This will give you peace of mind AND something to actually show for your money.

Laser companies do not like customers buying on the used market. They will treat you like a second class citizen and you will get third rate service and response from them. Depending on what laser you are looking to buy and how much training and upkeep it requires should be the main factors. Certain lasers have a good history of maintenance and others have a poor. It will be important to do your research on which lasers and manufacturers have a history of reliability and quality.

You also need to find out which laser manufacturers are user-friendly to pre-owned equipment. Some manufacturers can charge you a laser “RECERTIFICATION FEE.” Recertification fees are sometimes required by the manufacture if the laser device is sold to someone else. The laser manufactures claim it is to ensure the device has not been tampered with, however the real reason is to protect the manufacturer from being undersold by doctors looking to sell their used equipment. Charging a “recertification fee” levels the playing field between the new and used price. These fees can be as high as $25,000.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097