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Success in aesthetic medicine takes strategy, resilience, and a little bit of moxie.
Aesthetic Visionaries is where bold entrepreneurs come together to share real, actionable insights on building and growing a thriving aesthetic practice.
You already have the talent, the intelligence, and the clinical expertise. This series is your guide to navigating the challenges of entrepreneurship with confidence and clarity so you can reach—and stay at—the top of your game.
Think of it as your business coach, industry insider, and hype squad all in one. Minus the jargon and bad advice.
Ultimately, we’re here to help you stand out and sculpt a business that’s as polished and bold as your work.
Show ID (00:01):
Welcome to Aesthetic Visionaries, the show where we hear from bold entrepreneurs building and growing a thriving aesthetic practice. Let's get into it.
Mikyla Race (00:14):
Welcome everyone, and thank you for joining our Aesthetic Visionaries live event. Tonight is the device dilemma, cutting through the hype. I'm Mikyla Race from the Moxie team and I will be your host tonight. We are thrilled to have David Weir, NPC, here with us, one of the most respected educators in aesthetics and a true expert on energy-based devices, ROI strategy and practice growth. Tonight's session is all about clarity, helping providers like you make informed hype free decisions about technology investments. We'll have time for audience questions towards the end, so drop yours in the chat as we go. And while tonight's session is all about learning from David, I want to take a quick minute just to share who we are. For those of you joining us for the first time, Moxie is an all-in-one growth engine for aesthetic providers. Whether you're launching your first practice or scaling to your next location, here's how we help.
(01:05):
First, our proprietary software, Moxie Suite is built specifically for aesthetics. It includes your EMR, your CRM, your online store, your memberships, and your marketing tools all in one place. Second, we offer exclusive pricing on injectables, supplies and devices so you can keep more of what you earn. But what truly sets Moxie apart is really the people. Our internal marketing agency builds websites, runs meta ads, drives revenue generating events, and manages seasonal promos like our Black Friday playbook that help aesthetics get two times revenue in a single week. Then there's also the team that I lead, our Practice success team. We are your business coach, your strategist, your growth partner, and we're here to guide you every month, every step of the way. So if you're serious about building a profitable standout practice, you're in the right place. And if you'd like to explore Moxie even further, you can check out our new Moxie lookbook at www.joinmoxie.com/lookbook, or you can book a free introductory call with our team@joinmoxie.com/call. Now, let's get to the real reason you're here. I'm going to turn things over to David to dive into all things devices. Take it away, David.
David Weir (02:14):
Awesome. Thank you so much Mikyla for that introduction. My name is David Weir, I'm a nurse practitioner and I live in Dallas, Texas. I have a business called Ultimate Skin Source and I'm part of a much bigger business called the Dallas Plastic Surgery Institute. So I have been in aesthetics since September, 2001, so 24 years now. Not always an injector. I started in beauty and skincare and then went into med spa sales, sales director positions, beauty director positions, and then became a nurse a decade and a half ago and then became a full-time injector over a decade ago. I love to teach because I separate my time in three different areas. So the first area that I spend the majority of my time is of course, in clinic doing what most of you do, stabbing people in the face, burning their face off or tightening their skin.
(03:03):
My second full-time job is doing clinical research, so I do clinical research for the FDAI work with a lot of different companies, most of them that you are very familiar with in device filler and neurotoxin market as far as Allergan, Galderma, MERS, dioxane, Eli, revision, plated in mode, cyan, aclara. There's lots of different clinical trials that we've ran through our clinics over the years. So being a clinical investigator for the FDA is very important to me because A, I like to know what's coming out. And then b, I like to make sure that what we're doing is safe and effective and then my last full-time job is of running around the country teaching the biggest enemy to aesthetics right now are not educated providers. In fact, it's the providers that get into this or the unlicensed people that get into aesthetics and they just dunno how to ask the right questions and that's just because they haven't been in it long enough to understand that this is an ever evolving market and you're only as good as you were yesterday.
(03:59):
So if we can lift each other up and put community and collaboration over competition, it's a win-win all the way around the board. There are 8.7 billion people in the world. None of us can treat them all. So our goal and my personal mission in the education space is to make sure that providers out there are providing safe and effective treatments so they're getting good results. So more patients in the world start coming into our clinics asking for the things that we do on a day-to-day basis. So let's jump right into this presentation. So the device dilemma, cutting through the hype, that's me David Weir. My handle on Instagram is ultimate skin source. Don't judge me based on my Instagram. Again, like I've said, I've been doing this for over two decades and if I was going to advertise on anything, it would probably be like MySpace I hailfrom Dallas, Texas and I like to talk about energy-based devices because the aesthetic marketplace is really booming in this area.
(04:55):
If you look at this trajectory and poll done by Novo one advisor, you could see the amount of money and billions of dollars that the aesthetic industry is providing in energy based device treatments in our clinics. And this is a projected forecast from 2023 all the way up to 2033. So right now we're in 2025. It's about a $7 billion industry in the next eight years that is expected to almost triple. So why is it going to trouble? Why are people seeking out energy-based devices? Before we get into the different devices and some of the results that these devices provide and then my opinion on them and my clinical observations of these devices, let's talk about what's driving these factors. So why is the market increasing at such a high rate? The Body Cot touring and skin tightening segment accounted for the largest revenue share with over 20% in 2023.
(05:56):
Now this kind of makes me excited because I love devices and I love what they can do clinically, but it also kind of makes me a little sad because they're really one of the main components that's driving this minimally invasive to non-invasive energy-based market and body contouring market is social media and social media has lifted the standard of what looking good looks like with the evolution of filters, with the evolution of different apps that you can alter your appearance, the ideal beauty standard now is so altered that no one knows what's real anymore. And when we are looking online on a day-to-day basis and we're seeing these beautiful models with zero pores on their face, no hair, not a single fine line or wrinkle, sometimes it can kind of warp the perception of what true beauty is. But we as providers have to understand that's one of the major contributing factors that you driving this.
(06:59):
So I know a lot of us understand that we are full-time aesthetic providers and part-time therapists. However, we have to make sure that we are making sure that the devices that we're using match the result and are actually giving our patients the treatments that they're asking for. So what are energy-based devices? This is a very broad topic, so I'm just going to go over some of the most common energy-based devices that I see in the market and then show you some before and after examples. But there's lots, and if I was to, I have not been able to quantify how many energy-based devices are out there, but I do know there's over 20,000 skincare brands and just in the United States alone. So you can imagine there's tons of devices on the market as well. Some of them do the exact same thing as the other ones.
(07:50):
Some of them do very similar procedures and we're going to talk about some of these similarities between these devices as well. So we're just going to go from the most noninvasive to the most invasive skincare. That's going to be obviously going to be the least invasive possibility that you can offer in your clinic. A step up from that that's not even a device would be a chemical pill, and that's why I started over 20 years ago doing skincare and chemical pills. Now we're starting to move into some devices. So intense pulse light or selective photo thermal lysis. If you're looking in the literature or photo facial, if you're looking at nomenclature for online zooms and word engines, we also can provide neurotoxins and filler noninvasively lasers is considered in the energy device category and there's a plethora of different types of lasers out there. We'll talk about some of the science behind each of those.
(08:42):
Radio frequency, that's kind of a big buzzword right now, especially if you've been keeping up with the FDA and what the FDA has announced is their position statement warning patients to make sure that they're to a qualified provider that's providing radio frequency because a little bit of a good thing can be a great thing. A lot of a good thing can be a bad thing, and that's one of the things that we've seen with this specifically with radio frequency microneedling with some of the adverse events that are happening across the country as far as permanent scarring, as far as hyperpigmentation, as far as volume loss or fat reduction in unwanted areas. So the FDA listed a position statement and basically said it is very provider dependent and I believe that in a lot of devices I truly believe, and I tell this to my patients on a day-to-day basis, it's not necessarily just the device that gives you the result.
(09:42):
About 33% of it is the device, 33% of it is my expertise and my experience using the device. And then that last 33% that I can't control is how well you respond to the device and my experience using the device, knowing who you're going to and their experience using that device and their education using that device, and it can be just as important as the device itself. Another thing that we see is of course, micro-focused ultrasound. One that's very popular that you see out there is alt therapy. Then another modality of course being the most invasive option is going to be obviously your surgical procedures. So let's look into the first category, high intensity focused ultrasound and how does it work. So high intensity focused ultrasound is a noninvasive aesthetic treatment that focuses on ultrasound. It's right in the title, but that ultrasound targets various layers of the skin, including the superficial, all the way up to the deep dermis and sometimes even the subcutaneous tissue depending on what high food device that you have in your clinic.
(10:54):
Now we see these high intensity focused ultrasounds and we see them on the market and they're good additions to your practice if you get the right one. And you set the right patient expectation because what these do is they cause tissue contraction. So how do they cause that tissue contraction? Well, you focus ultrasound energy into the skin. That ultrasound energy at this level that you set it depending on the device you're using, causes thermal coagulation. That thermal coagulation typically above 65 degrees centigrade will start to cause collagen, disorganization, collagen breakdown, which leads to a rebound effect of collagen stimulation. So a lot of the devices that you'll see over the next couple slides work very similarly as far as some sort of injury to the skin and then the body's response to that injury to create new collagen along the wound healing cascade. What are the applications and benefits that we see with HIFU or ultrasound?
(11:55):
We have obviously per the FDA, a lot of them are approved for skin tightening and lifting approved for wrinkle reduction. You see some of these HIFU devices being offered for body contouring benefits to this. Of course, obviously there's it's noninvasive. There's very minimal to no downtime. It provides a nice subtle natural looking result and it's in the right hands can be very safe. This is a great option, especially if you have that lunchtime clinic where patients can have zero downtime. They don't necessarily have time to numb. You don't want to do anything that necessarily breaks the skin barrier because they want to put makeup on and go right back to work. So HIFU could be a great application to your clinic if that's the patient population that you serve. Here are some of the results of hifu. Now the important thing that I want you to note, and you'll see this later on in the presentation, that these before and after photos are not my own before and after photos for this presentation, I wanted to go to the manufacturer's website of each of these devices and see what they post on their own website as their before and after photos.
(13:07):
And the reason specifically that I chose this option to present to you tonight is because I wanted to show you what the company considers the best of the results that these devices can deliver. So are there other before and after photos out there that give less results or maybe even give better results than what you see here? Absolutely. But per the manufacturer, these are some of the best results that this device can give you. Here is another device right here. The first one is ultra former. This is your old therapy device and you could see, definitely see a change in the skin quality in each of these patients. I typically look at the oral commissure and then the jawline to see if I see differences in shadows, differences in neck banding see differences in transition from the J fat com up to the prejowl or differences in the nasal labial fold depth.
(14:03):
And you can see in each of these three patients there is a noticeable change. So these are some great old therapy results. Next step, this is another great ultrasound device and these are to me some really good results. And again, look at the jawline contour, look at the improvement of the skin laxity and then look at the nasal labial fold. This specific device that shows these before and afters of course is going to be soft wave. Another newer ultrasound high frequency ultrasound device on the market that's been approved for just the past couple years. So radio frequency. Now radio frequency comes in a lot of different forms, but how does radio frequency work? It's an aesthetic treatment that's used for skin tightening and wrinkle reduction in body contouring. It works by using radio waves to generate heat rather monopolar or bipolar into the deep layers of the skin, stimulating collagen production and promoting tissue remodeling.
(14:59):
One of the things that radio frequency, specifically radio frequency microneedling that may have an advantage over HIFU or ultrasound type technology is that it doesn't have to pass through the epidermis and dermis. The needles themselves act as your delivery mechanism. So you can go deeper into the soft tissue underneath into more of the papillary dermis or the deeper part of the dermis or even the subcutaneous tissue if you want to cause coagulation in that area. In fact, some of the early radio frequency devices were not even approved for skin tightening. They were approved for tissue and fat coagulation. Now secondary to tissue and fat coagulation is going to be skin tightening, increased collagen in collagen remodeling and then secondary to fat coagulation will be lipolysis or death of the fat cell or opening in disposal of the contents of the fat cell causing fat reduction.
(15:58):
So if you understand how the technology works, then you can use it appropriately and set the correct patient expectation. So how does radiofrequency work? Again, this is going to be a very common theme throughout this presentation. You have energy delivery, a thermal effect, which results in collagen stimulation. So all devices are working to create a controlled injury that results in neogenesis, elastin, agenesis or some sort of fibroblast activation to activate those two pathways. So the applications for rf, whether it be bulk heating or needling includes skin tightening and liping wrinkle reduction, body contour, minimally invasive. I wouldn't say it's completely noninvasive unless it's a bulk heating device versus a microneedling device, but they generally provide minimal to no downtime and of course provide natural looking results. And safety is very provider dependent as far as who is administering the treatment and what their expertise in that treatment is.
(17:02):
Here are some of the before and after treatments. This is with a very popular rf, my device called Morpheus eight. Again, these are pooled from the manufacturer's website. You can see improvement in skin quality. You can definitely see wrinkle reduction. I have a Morpheus eight device in my office. I use it on the daily basis and I actually prefer to treat patients that have this type of skin elastosis or solar elastosis in their skin. So when we look at the before and afters, there's a parent results. If I have a 23-year-old that comes in that says I want my jawline to be sharper radio frequency, even though it may give you a 10% improvement psychologically it has to be greater than 10% for your mind to even recognize that there's been an improvement. So I like some of these before photos because these are patients that I would treat with some of these devices because they have static lines and wrinkles.
(18:04):
So I have a nice baseline that I can show them before and after there has been a positive change in their skin. Here is another RF microneedling device and this before and after photo on the scar is something that I use regularly in my clinic for scar reduction. Radiofrequency microneedling is an awesome tool for scar reduction because scars in themselves and working with 16 plastic surgeons, I get a lot of referrals to help minimize the appearance of scars, especially high tension scars like brachioplasty, thighplasty or abdominalplasty scars. Like how can we reduce the appearance of these? So not only do you look better and feel better, but you also look good in your bathing suit. Your scars are noticeable radio frequency or if you look at scars just in general, scars are just an overdevelopment of disorganized collagen and radio frequency microneedling can go in and emit heat then cause that unorganized collagen to have an injury response, which forces the body to reorganize it and to smoother more homogenous collagen.
(19:15):
And that's why you could see this great improvement in scarring, especially on this before and after. Here is another radio frequency device. This is a bulk heating device. So this one isn't using needles, this is using bulk heating. So this is transcutaneous application and it's commonly known as Thermage. And you can see these are some nice results. Now is this going to give you the result of a facelift or an upper bluff? No, I will say the patient that almost looks like she had an upper bluff, I think that's amazing. That's an excellent result. But will every patient get that? I wouldn't set that expectation. I always under promise over deliver. So when I'm talking devices, I tell patients, if we can get a five to 15% improvement per treatment, will that make you happy? And then if it does make you happy, if we compounded that and added one or two more treatments to that, would that make you happy?
(20:10):
And if they say yes to all of the above, then I'll move forward in those devices. Here is another full Keating device. This is a topical bipolar radiofrequency device that causes bulk heating, again, causing that tissue contraction, causing neocollagenesis and tightening that fibro septal network to help smooth and tighten the skin lasers. Now lasers is one of my favorite categories to work in. I have two types of patients, either I peel your face off like an onion layer by layer and we do it over the course of several treatments or I just cut the onion in half and I just burn your face off about once or a year or once a year or once every other year. But there's several different types of lasers. Each laser has its own set of characteristics, own benefits, and of course obviously potential side effects. So what does lasers do?
(21:01):
Lasers specifically are light amplification. It's taking laser energy, amplifying it through a giant device through different mechanisms to cause selective photo thermo lysis or target a specific chromophore in the skin or to target a specific type of molecule in the skin. Most lasers work on water. They tend to go after water in the skin. And what does that do? That causes controlled damage, which activates controlled healing to create more neocollagenesis dermal thickening as sometimes as well as ELA agenesis or skin removal if you're using a high ablative frequency in lasers. So here are some of the most common lasers that we see on the market, some of the older ones you see on the left, I see PD L, pulse stylus, lasers amazing, great for your vascular lesions. And you could see because how right where they go down into the dermis, into those superficial blood vessels.
(22:02):
That makes sense. The Alex and YAG both really great lasers. You see those a lot in laser hair removal. You could see how they can penetrate deeper into the dermal blood vessels, which is responsible for providing the blood supply to the hair bulbs. And that's why you see those commonly used in things like laser hair removal. Then you have different types of erbium and CO2. So these are going to be more of your aggressive superficial resurfacing lasers that can either cause complete ablation or even non ablation depending on the manufacturer. So what do lasers do? Of course their applications are skin resurfacing and you have either ablative versus non-ablative and depending on your patient population, if you treat only fits one through three, then you might lean more towards ablative. If you are treating fits four through six, then you might lean more towards non-ablative.
(23:00):
If you're wanting something that can provide an aggressive treatment with aggressive results, ablative might be the way to go. If you want something that you can do year round regardless of sun exposure or something like that, then non-ablative might be the way to go. Hair removal, of course we talked about the aex and the yag, but also diodes are also great for hair removal. If you're in the hair removal business, the vascular lesions tend to respond best to pulse size lasers and those are specifically targeting that deeper papillary dermis where that vasculature lives to help things with cherry angios or port wine stains, any sort of vascular lesion pigmentation. A Q switch laser is fantastic at pigmentation, of course not laser selective. Photothermal lysis is also great at pigmentation, which is like your five 15 or 5 85 intense pulse light device. Different types of blue light and fractional where excellent in acne and acne scarring, especially if you have a medical dermatology practice or you're seeing patients in that spectrum.
(24:09):
I am 100% aesthetic and if I see anything suspicious, I have a great dermatology practice that I refer to. So I am not an expert by any means in med derm. I'd consider myself more of a entrepreneur and expert in aesthetics. And then of course you have your skin rejuvenation, which we see in our non-ablative fractional lasers. So here are some nice before and afters, some of the possibilities of different lasers. And then you could see the nice thing with lasers, not only can you get skin tightening, but you can get skin reduction. You can get skin smoothing with superficial fine lines and wrinkles because you can resurface with lasers. And then you can also help clear out any pigment that is in the epidermis or sometimes in the superficial layers of the dermis because these lasers can help resurface and help to thicken the dermis themselves.
(25:03):
And then some lasers like this bottom lip are approved specifically for diffuse redness because when you thicken the epidermis and dermis, you can disguise the redness underneath the skin or in the papillary dermis. Here is some common before and afters that I see in my practice as far as more aggressive lasers. These are more your CO2 type results. They're CO2 awesome lasers. There's several companies that make different types of CO2 lasers with CO2 typically you could see from this bottom left picture it can be kind dramatic for the patient as far as the healing is concerned. But you could see two weeks post what a tremendous difference there is in the quality of skin as well as the rites peri orally and the oral commissure and periocular on this patient. So yes, was it an aggressive treatment and did it have aggressive downtime? Absolutely, but the results speak for themselves.
(26:05):
Here is some common things that you can do with a pulse dice laser. So looking at this rosacea patient looking at this vascular dismia on the top left and the right, again, pulse dye lasers work by going, traveling deeper into the skin, bypassing the epidermis, going into that papillary dermis and then causing the blood vessels that are contributing to these vascular lesions to be cauterized and collapsed. And therefore the blood flow no longer exists so the diffuse redness is reduced or improved or completely eradicated. Here is some more before and afters especially on body. I've gone because I treat the same four to 500 patients annually, I don't see a lot of new patients because I've been in practice for so long. A lot of our newer patients go to my other providers, but body is something that I do a lot more of than I did 10 years ago because my patients have stopped aging above the neck and now we're working below the neck.
(27:10):
So this is a great before and afters with IPL and BL. These, these are actually a couple of my results. This is with a lighter erbium laser that I do in office under topical numbing. These are single session results with a three month post photos. You can see nice improvement in overall texture to the skin, fine lines, wrinkles, and these are laser results only. There's no toxin or filler or skincare or anything like that that was added or adjunct to this. This is just the before and after of laser results. So you could see, you can get some really nice results with some of the more aggressive lasers if you have the training and the confidence to use them. Here is another before and after result. This is the UltraClear laser, which is a combination of fractionated erbium plus completely ablative erbium, which can go as little as no ablation, no coagulation all the way up to full ablation if you want to.
(28:14):
It's a very customizable laser. And you could see, oh, not only did this before and after treat acne scars and dismia, but it helped with overall skin rejuvenation and rites and then thickening that epidermal dermal barrier, improving the skin quality and tightening the lower face significantly. In this bottom right, this is more of a completely ablative erbium treatment because of the amount of solar elastosis and skin laxity in deep rides that the patient has. But to be a non-surgical result with one to maybe two weeks of downtime, you could see this patient should be very, very happy with her six weeks post one treatment result. To recap, these are the different wavelengths of lasers. This is a great screen to screenshot if you want. Looking at the depth of how these different lasers go into the skin. And if you understand the diagnosis of your patient and what the problem is or what their chief complaint is, this slide can help you to choose what type of laser might be most appropriate to treat their main concern or the problem that brought them into your clinic.
(29:23):
So here are some pearls when it comes to capital equipment because like I said, I've been in this industry for over two decades. I have millions of dollars of capital equipment in my office. I haven't even counted them, but I just got my second software. So I own the entire in mode suite. I have two soft waves, we have several cyan devices. I have an UltraClear laser, I have a glow to facial. We have HydraFacial downstairs and our med spa, we have a care lace. I mean, so we have tons of different equipment in my practice, some of them I love, some of them I kind of regret. So I want to give you some kind of capital equipment, pearls since you're all business owners and are potentially business owners working and partnering with Moxie. I want to give you some pearls that kind of like, I wish I would've known this 10 years ago, or I wish somebody would've told me this when I got into aesthetics.
(30:22):
So don't buy them now, that's a joke. But when it comes to capital equipment, a lot of these devices are very expensive. So my first warning sign is to tell you don't buy them without a sound sound business plan. So I have to say, I'm just kidding. I do buy them, I use them. But there's lots of things that you have to consider before you make a capital equipment purchase. So let's jump into some of this. So you need to ask yourself these questions. Do I have the patience for this device? Do I have the staff or the time in my schedule to do this treatment? Do I understand the science of the device? So those are three questions that you really need to sit down and ponder with before you make a purchase, before you sign anything, before you really even agree to meet with some of the vendors that are selling you these devices.
(31:23):
Because in my office time is money. So if I'm spending 10 to 15 minutes to meet with you and there's zero possibility that this device is going to work in my clinic, that's 10 to 15 minutes that I could have saw a neurotoxin patient, a new patient consult, a filler patient. So that is money lost. So you have to make sure, do you have the patience for this? Not the patience to learn how to do it, but the patience to actually buy this service that this device offers. It would make zero sense. If you are in a certain part of the world and you are only treating Fitzpatrick five and six patients to buy a fully ablative laser, that would make zero sense or an IPL device because those devices do not work well on patients with skin of color. And then quite the opposite, if you have patients or if you have zero patients that have zero interest in treating port wine stains or medical dermatology issues, it would make no sense for you to own a pulse die laser or to invest in that.
(32:32):
Do I have the staff or the time in my schedule to do this? That's the other thing that you really have to weigh out in a minute. We'll do a little exercise about how to pay off a device and how to make sure that you're profitable. But if you are a solo provider or you have multiple providers, you have to weigh in, do I have time in my schedule if I buy this device to make sure that I can keep the device busy enough with the patients that I have and fit that into my working calendar that I'm not pushing my other normal day-to-day patients out of the way to be able to spend time using this device. And then do I understand the science of the device is key here because earlier, just like the FDA came out with its warning statement with RF microneedling, it is provider dependent.
(33:20):
So a lot of these companies will offer training and I would highly recommend that you get that written into your contract before you by any sort of device, what type of pre-training will happen and then what type of ongoing clinical training and clinical support is necessary and make sure that is 100% outlined in your agreement before you sign anything or send money to anybody or agree to finance any sort of device. Other questions you should ask yourself is, can I afford this device? How am I going to pay for it and when will I be profitable? So these are questions. As a business owner, you really have to understand because it makes me very sad when I see on a day-to-day basis, there's several groups that I belong to on Facebook and threads and other social media platforms that it's so disheartening to see. And if you're on this call, maybe you've seen this before, when people are trying to sell a device because they purchased it and then they realize they can't afford to keep it and then they're upside down on their lease or they're upside down on their payments or they're behind on their payments and they can't offload it.
(34:40):
And then a lot of these device companies now require relicensing fees. So let's say you buy a device for $50,000, you realize after a year you can't afford it, it's not popular in your practice. And then for whatever reason, you didn't read the fine print on your paperwork when you decided to finance this device because that's how you decided to pay for it. And then you realize that the loan was interest forward. So for 12 months you've been paying just interest and nothing towards your capital. So at 12 months you still owe $50,000 or even more on a device that you thought you only paid $50,000 for. And then you're trying to sell it and you find out there's a relicensing fee, which means the company might charge you or the person that buys it from you, an additional 5,000, 10,000, I've seen as high as $20,000 to relicense that device to another provider.
(35:44):
So at that point you're so upside down that you're just stuck with it. And the saddest thing I see is that people don't understand the business because they're brilliant injectors. They're beautiful artists, but they didn't go to school and they didn't go to school to have a master's in business. They went to school to be a nurse practitioner or to be an RN or to be an aesthetician. They didn't go to have a business degree. So when you sit down and you're trying to run a business, some of the best providers that provide the best results unfortunately end up going out of business because they don't see the future and they're not sure how to plan. And I think that's awesome and a great part of Moxie. And one of the reasons why I like to train for Moxie is because I wish when I got into aesthetics two decades ago that there were programs like this to have ongoing education, clinical support, and business support and financial tools to help me make clear sound decisions when I was starting my business.
(36:46):
So when will I be profitable? We'll do an exercise on that. Here are some more questions you need to ask yourself, what is the long-term financial outcome? And my personal experience will tell me to tell you that if you cannot buy a device, pay it off within about 12 months and then be 100% profitable. I don't think you should value the device. And I know that might be hard for some people to hear, but the aesthetic market is changing so rapidly and technology is advancing so rapidly at the same rate. So a device you buy today might be obsolete 12 to 24 months from now. Imagine the iPhone every year they come out with a new one and a lot of people get the brand new one because of the marketing of the iPhone, even though it might just be a little bit better than the last one.
(37:46):
There's a very famous laser company that just came out with a device that combines three of its treatments in one. Well, you could still use the old one, but now all the marketing is going towards that three treatment in one device. So patients are now calling for that three treatment in one device, but you just might have bought its predecessor a month ago and now that marketing is not being spent towards you or the device you bought a month ago, it's being spent towards their brand new device. So what is the long-term financial outcome and how quickly will you be profitable? Next question is, does the cost of the treatment match the outcome? And I think this is one of the most challenging things for any aesthetic provider to truly work with is because when it comes to neurotoxin and filler and bio simulation, more than likely the price matches the outcome if you're pricing favorably.
(38:45):
But with some of these devices that may cost you a hundred thousand dollars. How much do you have to charge per treatment to not only pay yourself, pay the device, pay your rent, pay your bills, et cetera, but does that cost to match the outcome that the patient is receiving? Because, and we see this in aesthetics, and I see this on a lot in packages, especially with radio frequency microneedling. When it first came out, I charged more than what I charge now, and that's just because I know now after doing it for over a decade that sometimes the price that I was charging 10 years ago didn't match the outcome that I got after three to six sessions. So I lowered my pricing on it to make it fair to my patients. What is your contingency plan? What happens if you have to go on maternity leave?
(39:39):
What happens if you break your arm skiing? What happens if your spouse asks you for a divorce? Or what happens if your clinic burns down? I mean, what is your contingency plan if the life you have now changes drastically and you can no longer afford to keep this device? What does the contract say? Or what does the financial agreement that you made when you purchased the device say if any of those things can't be met? So it's very important to always have a contingency plan before you make any sort of capital equipment purchase. Does the result match the cost? I really like to harp on that, and that's something that you have to simmer with on your own. And before you bring on a AV bias, look at some before and afters. Do demo days. I highly encourage you to reach out to another provider in your local or national market that offers that service and ask them to shadow.
(40:39):
Go see them, do a couple treatments, ask them to see some of their own clinical book before and after photos. Get a provider to provider or peer to peer collaboration before you go any further with any sort of device. Because these companies that are selling us these devices, their goal is to get us to buy the device ultimately, and they're going to show us the best of the best. I don't want to know the best result that you've had with let's say radio frequency microneedling. I want to know what your last 10 results look like with radio frequency microneedling. By doing so, you'll be able to make a more educated decision on what you want to do when you purchase a device and if it's right for you and your patient population. So here are some things that patients are willing to pay, especially the benchmark InterG based devices including laser rf, ultrasound, BBL, micro kneeling radio frequency typically are running 600 to $1,500 per session.
(41:43):
A lot of these devices are sold in packages. And then of course I'm in this last end, I do a lot of aggressive erbium resurfacing. So some of my treatments are in the cost range of upwards of four to $6,000. But when I look at my own before and after photos, my patients never BLK at the price because they look at the differences in their skin, the quality of their skin, the tightness of their skin, the anti-aging effect that I provided for them. And they agree the cost that I charge in my clinic matches the outcome. So perceived Valium, most patients are able to justify anywhere between three to $6,000 annually for overall maintenance of their skin health and their appearance. Now that's overall beauty. So if they're spending a thousand dollars or let's say $500 a month on a gym membership, that might max out their aesthetic pocketbook.
(42:36):
If you are charging them $5,000 a year for toxin filler, that might max out their aesthetic pocketbook and they can't afford to do anything else but toxin and filler with you. So another thing you have to understand in your patient population is what is my average patient spend? What are they spending money on? What devices would compliment the services that I currently offer? And you can do it as easily as pulling your patients that come in before you buy a device. If you're interested in three different devices, make a little questionnaire and for 60 to 90 days, ask your patients to check off or write out what device or what treatments they would be interested in having in your practice. I do that in my practice before I bring on a device, and that's how I've been able to pay off devices very rapidly. There is a lot of psychology in what we do, especially non-invasive versus surgical procedures.
(43:30):
Patients are willing to pay a premium for less downtime. So I just purchased a new laser, it's called a UltraClear. Before that we had the contour or actual, which is a cyto product. We still have both of them. But the reason why I purchased the UltraClear is because I could get the same results as my prior laser with less downtime, typically half to a third of the downtime and it's more comfortable so I can do it with topical anesthetic versus having to put them under sedation or do nerve blocks or something, any sort of more invasive anesthesia. So that's a sound reason why I decided to bring on and purchase a new $200,000 laser. Specifically for the convenience premium. There is also the fear discount. Patients will pay less if the procedure is painful, risky, or experimental. I'll have to pick on radiofrequency microneedling here because even though I get really good results with it, it's kind of some of the times it feels like you're getting stapled by lightning.
(44:32):
It's a pretty intense treatment and that can be a barrier to some patients. And then the longevity multiplier, if you can do aggressive treatments or treatments that you can bring patients in that have long lasting results, patients are willing to pay a much higher premium for it. These are some of my quantifiable patients in my range. Patients that just want a quick fix, they're willing to pay about 500 to a thousand dollars a session. They want very little downtime. They're more than welcome to come in multiple times a year. You have your skin investor patients, those are the ones that like to spend five to $8,000 a year. They're totally fine with stage non-invasive programs because they don't want to have surgery. And then you have the true surgery of order. Now, these patients I typically quote very high because I want a very high threshold.
(45:20):
If someone comes in and they obviously need a facelift, I'm probably going to put them in this surgery ofor category, and I'm going to go over every possible thing that I can exhaust them at to give them a very, very nice result. And even then I will tell them that at my best, I might be able to get you 30, maybe 40% close to a facelift. But if you're willing to spend 10 to $15,000 over the course of 12 to 18 months, then we can do that. But if you truly want overnight results, maybe a surgical option is better for you and you should go for the $40,000 facelift. So here are some things I say don't fall for it. These are things that I've heard from companies that companies have also failed me on when it comes to devices is we'll help you get clients.
(46:07):
Devices typically don't bring in clients whatsoever, and most of these device companies are very used to over-promising and under-delivering versus the opposite, under-promising and over-delivering. So devices won't bring in new patients. You have to focus on devices that your current patient population will accept. That fills a gap in your services. There's no such thing as a lunchtime procedure or a downtime procedure that gives good results. I hate to say no pain, no gain, but if it doesn't hurt, it doesn't work sometimes. And we have to make sure that the price, if it is a non-painful procedure, matches the frequency of services that have to be offered. So I do have some non-invasive, non-painful, no downtime lunch procedure services in my office, but my patients know that you have to come in once a week. You have to do it for four to six weeks, then you have to come in for monthly maintenance.
(47:02):
And if that's what fits their schedule and they don't want to have any pain, then go for it. Other things I hear is our product is the best. There are dozens of different types of lasers. There's dozens of different types of R microing devices, and I highly encourage you to meet with several of them before you make any sort of investment. And then there are no hidden fees. I've heard that before. And that's something that you have to really look at the fine print of your contract, make sure that you have a lawyer or someone who specializes in capital equipment purchasing or contracts onboard before you sign anything because you want to make sure that there's nothing hidden in the fine print that might end up biting you such as not being able to re-license the device or such as having to pay a specific service warranty or something like that.
(47:50):
After the manufacturer warranty runs out, make sure you understand what the hidden fees are. This is something that you can screenshot as well. We're getting towards the end of this presentation, so we're going to open it up to q and a here in just a couple moments. But you can screenshot this. This is something that you need to fill out so you can understand if you're going to be profitable on a device before you purchase it. Here's just a quick exercise. Let's say a device costs a hundred thousand dollars. The consumable per treatment is 75. Your cost of labor is $50 an hour. Maybe that's what you're paying yourself or you're paying your RN or NP. So your variable cost per treatment is now maybe about $150. When you take everything into account, your average charge that you could charge for that treatment is a thousand dollars.
(48:39):
So your contribution margin per treatment, a thousand dollars treatment fee minus $150 to do the treatment is $850 profit. So if you do buy a hundred thousand dollars device, you charge a thousand dollars per treatment, it's $150 costs to do the treatment. Your profit is eight 50. You have to do 118 treatments before that device becomes profitable. So what does that look like? And then do you have the labor to do it? So in 12 months, if you have to do 118 treatments, you have to do a minimum of 10 treatments a month just to break even. And that would require about 15 hours of work. If you want to do, let's say you cut that in half, six months. You want to do six months to pay off this device before you become profitable. That means you need to do 20 treatments on average per month, and your 21st treatment that month is when you become profitable.
(49:38):
But again, that's 30 hours worth of work. Do you have that time in your schedule to do it at a thousand dollars of treatment? Last one is one month. This is what I like to do. I like to pay devices off in a month. I know that sounds crazy, but I tend to pre-book devices. So if I am bringing on a device, I start marketing it about three months before I bring it on. I offer an introductory special, which isn't a discount, it's typically a skincare ad, which means you get the cost of all your pre and post-care included in the fee for the device, which is typically around a five to $600 bonus gift for you when you sign up. And then for the first month after I buy a device, I'm doing that device constantly. In fact, I did that with the last laser that I purchased. It took me a little longer than four weeks. It took me six weeks, but in six weeks I was able to pay off a $200,000 laser because I pre-booked it.
Mikyla Race (50:33):
Alright, thank you so much, David. That was fantastic. I really loved the pearls on the capital equipment. It was so great. So I hope everyone was taking notes. And thank you again for giving us such a transparent and practical perspective on what's really happening in the device world. So before we wrap, let's jump into a few of the top questions from our live audience. Feel free to drop any additional questions in the questions box. We'll get to as many as we can. David you up for a little Q and A.
David Weir (50:58):
Let's do it.
Mikyla Race (51:00):
All right, let's go. So from Shannon. David, do you have a device that you prefer? Amilia?
David Weir (51:06):
Ooh, Amilia. Solia is hard and honestly the best thing amilia is either something very light resurfacing. So you could do like a nano pill, a micro laser pill, which would be like a cyan device. You can do a 3D Miracle, which would be like on an Alux device or an UltraClear device. But I also find Amelia really responds well just to tretinoin if the patient can top or tolerate it. If they can't respond to Tretinoin, then you can spot treat Amelia. But that's an excellent question and it's one of the harder things to treat.
Mikyla Race (51:40):
Yeah. Okay. Let's see. From Jen, if full ablation, what type of skin regimen is needed after the treatment?
David Weir (51:49):
That's a million dollar question, and I've tried all of it. So if it's full ablation, you are completely eradicating the stratum cornea, so you have to make sure that you are putting on something either semi occlusive or something occlusive to protect the skin barrier as it heals. So most of the clinical trials for full ablation use old school Aquaphor or petrol atom. I like to take it up a notch and actually provide something a little bit better. If I use product names. There's Neo Ova, which is that they have a tissue repair cream that I really like. I use Elastin Sooth and Protect, which is an awesome recovery product that I use for especially a lot of my really aggressive patients. And then I use a platelet derived growth factor from Plated. So those are the majority of mine. And then I use a very, very gentle cleanser, either a nice gel cleanser or a creamy cleanser post-treatment.
Mikyla Race (52:44):
Awesome. Okay, great. Have you ever invested in a device that didn't deliver what you expected? And don't name names, but what was your takeaway from that experience?
David Weir (52:55):
Yes, experience. Experience I have, because I have some very expensive paperweights in my office is what I call 'em, like
Mikyla Race (53:04):
CLO hangers.
David Weir (53:06):
Yeah. Some of the devices were like early cellulite type devices. I'm not going to name names. Some of them were bulk heating devices that would cause temporary skin tightening would look really good. But it was one of those things that you had to do every week or every other week to maintain the results. And as a nurse practitioner, if I had maybe an unlicensed person that I could delegate that to, or someone who is very passionate about a body contouring, that their cost of services was much lower, that it made sense and maybe offered a membership it would work with. But in my practice, I just don't use 'em because the time it takes to get the results is too costly for me and my providers.
Mikyla Race (53:49):
Yeah, fantastic. Okay, so if attendees want to learn more from you, what's the best place to connect?
David Weir (53:56):
Oh, Instagram is probably the easiest thing. And you can just DM me on Instagram. I do run a very busy clinic, so it might not be during the day that I respond. It might be definitely after hours that I respond. But my Instagram handle is ultimate skin source, and that's all one word. So just follow me on Instagram and I will be able to respond to your dms. And if it's anything that I think we should set up a call on, we can do all that through Instagram. I'll share my business email with you through my Instagram account.
Mikyla Race (54:28):
Amazing. All right, well, it looks like we are just about at time. So thank you so, so much, David for this amazing overview and to all of you for spending your evening with us. If you missed anything or just want to rewatch this incredible session, be on the lookout for an email in your inbox tomorrow afternoon for the recording of tonight's event. And don't forget, one lucky attendee will win a 30 minute private virtual call with David Weir to go deeper on your own device strategy and practice planning. We'll announce the winner tomorrow on our Instagram at Join Moxie. And lastly, be on the lookout for more events like this coming soon. You can register at any time at join moxie.com/events. Or if you'd like to chat more and learn more about Moxie, feel free to book a call with our team. It's always free. Join moxie.com/call. That's it for tonight. Thank you again to David. Thank you all for tuning in, and we will see you all soon.
David Weir (55:20):
Thank you.
Mikyla Race (55:21):
Bye. Thanks.
Show ID (55:26):
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