How, why to start a laser practice

Laser and light device treatments are infiltrating cosmetic and medical dermatology, causing many in the specialty to consider starting or growing laser practices. While the decision to go into the laser side of dermatology works out well for many, it can be a costly mistake for those who don’t do their homework, experts warn.

It was 1990 when Tina S. Alster, M.D., started her laser practice.

Dr. Alster says she knew of no other laser practice in the world at the time. She called it the Washington Institute of Dermatologic Laser Surgery, even though she only had one laser.

“… That was a pulsed dye laser that we used to treat port wine stains and hypertrophic scars,” says Dr. Alster, who still directs the laser practice in Washington, D.C.

Since then, Dr. Alster’s practice and laser technology applications in cosmetic and medical dermatology have flourished.

READ MORE: Evaluating which lasers are the best fit

“I’ve pretty much added at least one laser a year since I opened my practice,” Dr. Alster says.

Bruce Katz, M.D., opened the Juva Skin and Laser Center in downtown Manhattan, New York, in 1998. Since then, the practice has grown to more than 50 lasers.

“Laser technology is so sophisticated now that if you don’t have lasers in your practice you’re not going to be treating a lot of conditions as effectively. We know these devices are very effective at what they do,” Dr. Katz says.

Growing one’s practice

Another dermatologist and pioneer in the world of lasers: Michael H. Gold, M.D., medical director of Gold Skin Care Center and Tennessee Clinical Research Center, Nashville, Tennessee, says the laser practice he started some 23 years ago features more than 40 devices today.

“I started in the laser business through a chance meeting with the head of the then ESC Medical who asked me if I would be interested in trying to remove hair with pulsed light. That was a novel concept many years ago. From there … I began working with many of the technologies that we have on the market today,” Dr. Gold says. “Lasers and light sources were a way to introduce my skills and my practice to the people in middle Tennessee, and this was very helpful in growing my clinical practice.”

But things have gotten more complicated since the pioneers in dermatology started their laser practices.

Finding the financial wherewithal to start a laser practice with one laser in 1990 was hard enough, says Dr. Alster, clinical professor of dermatology at Georgetown University Hospital, Washington, D.C. Today, laser and other device options are vast and the costs associated with owning or leasing the technology can financially strain dermatology practices.

Starting a laser practice takes planning and requires dermatologists don’t try to cut the wrong corners, Dr. Katz says.

“There are specific technologies for specific conditions. The problem people get into is they buy one or two devices and try to use those for things they really aren’t indicated for. That ends up backfiring on them because they’re using the laser inappropriately,” Dr. Katz says.

Next: Identifying a need

Test the waters

Whether a dermatologist should open a laser practice is based on sound business principles. Is there a need? And can a dermatologist accommodate the need for less than what it costs to start and run the laser business?

Dermatologists just getting into practice should look at the need in their communities, asking whether there’s room for a laser practice, says Elizabeth L. Tanzi, M.D., clinical professor of dermatology at George Washington University Medical Center and co-director of the Washington Institute of Dermatologic Laser Surgery.

“(Having a) really good, solid business plan before engaging in any sort of investment is a wise thing to do,” Dr. Tanzi says.

Dermatologists should look at the communities in which they practice or plan to practice to see what technologies are already available, according to Dr. Gold. Depending on the supply and demand, a dermatologist might want to open laser practices similar to those in the community, but often, the goal is more to differentiate themselves from what’s already available at other dermatologists’ offices, he says.

Tap existing patients

Existing dermatology patients are a built-in supply chain for laser practices. Determining that need should be a first-line approach for experienced dermatologists who want to get into the laser business, says Dr. Katz, who directs the cosmetic surgery and laser clinic at Mount Sinai Medical Center, New York. This exercise also helps dermatologists determine which lasers they should get to meet the needs of their patients.

First, define the practice, Dr. Katz says. Does the dermatologist have a practice full of older, fair-skinned patients, with a lot of sun damage in Florida, for example? Or is it an urban practice catering to younger people of all ethnicities, who might be more interested in having toned, fit looking bodies than in facial rejuvenation? Still other dermatologists might focus on patients in the inner city, who want their tattoos removed.

“You have to think about the demographics of your patient base to determine what kind of laser is going to be used most frequently,” he says.

Medical dermatologists might ask themselves a different set of questions, according to Dr. Tanzi.

“Do you frequently refer to a surgeon? Do you see a lot of scars in your office from skin cancer surgery? Do you want to be able to treat those patients? Are you seeing children?” Dr. Tanzi says.

Terrence Keaney, M.D., assistant clinical professor in dermatology and urology at George Washington University and a dermatologist who practices with Dr. Alster, says lasers were a must-have when he started a men’s cosmetic center within the Washington Institute of Dermatologic Laser Surgery. Men are more accepting of lasers than they are of other cosmetic procedures, he says.

“What I’m finding with male patients is injectables still have a little of that taboo. Men are more comfortable with the treatment of rosacea, or the treatment of a pre-existing scar or a birthmark, and that often leads into other procedures, like injectables,” Dr. Keaney says.

Next: Laser practices not for everyone

Lasers not for everyone

While lasers are popular and might be a smart business move for many dermatologists, laser practices aren’t for everyone, experts say. The equipment can put a damper on your bottom line if it isn’t used. And some dermatologists simply don’t have the patient base to justify a laser practice.

“I don’t think it’s necessary for someone who is doing pediatric dermatology. They might need a laser for port wine stains but don’t need it for anything else,” Dr. Katz says. “Or someone who is just doing clinical dermatology might not need a laser at all. It depends on your practice and patient population.”

Money is big issue for many dermatologists who might otherwise start or expand their laser practices.

“Not only are (lasers) expensive to purchase, but they’re also expensive to maintain,” Dr. Tanzi says. “Maintenance costs of lasers can be upwards of $8,000 to $10,000 a year per laser. So, these are all things to consider before investing in lasers.”

Jessica J. Krant, M.D., M.P.H., who practices on 5th Avenue in New York City and is an assistant clinical professor of dermatology at SUNY Downstate Medical Center, says she has lasers at her solo practice and would like to have more.

“But I simply cannot afford them,” she says.

Disclosures: Dr. Alster reports financial interests in Cynosure, Home Skinovations, Palomar and Syneron. Dr. Tanzi is on the medical advisory board for Zeltiq, Miramra and Clarisonic. Dr. Keaney reports no relevant financial interests.

Read more in the series:

Evaluating which lasers are the best fit