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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_19_библиотеки_им_акад_М_И_Перельмана
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244 Essentials of neuromodulation
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Table 12.1 Understanding risk—cont’d
Muscles to
inject Intended outcome Complication risk Depth of injection
Mentalis Softens the mental
crease and the
cobblestone
appearance of the
chin
Platysmal Soften or eliminate
bands of the neck
“lizard neck”
May inadvertently
inject DLI and
cause a crooked
smile
Difficulty lifting
head off the
pillow, dysphagia
Deep inferiorly
and superficial
when you near
the mental
crease
Pinch bands and
directly inject
deep into the
platysmas band
References
American Society of Plastic Surgery (ASPS). (2019). 2018 Plastic Surgery Statistics Report.
Retrieved from https://www.plasticsurgery.org/documents/News/Statistics/2018/
plastic-surgery-statistics-full-report-2018.pdf.
Chestnut, C. (2018). Restoration of visual loss with retrobulbar hyaluronidase injection after
hyaluronic acid filler. Dermatologic Surgery, 44(3), 435–437.
Weiss, L., Silver, J. K., Lennard, T. A., & Weiss, J. M. (2007). Botulinum toxin. In Easy
Injections (pp. 160–165). Butterworth-Heinemann. https://doi.org/10.1016/b978-
075067527-7.10008-9.
Further reading
Allergan. (2020). Botox cosmetic history. https://www.botoxcosmetic.com/what-is-botox-
cosmetic/botox-cosmetic-history. (Accessed March 2020).
Dysport. (2020). For health care professionals. https://www.dysportusa.com/healthcare-
professionals#importantsafetyinformation. (Accessed March 2020).
Jeuveau. (2020). Ready for a modern-made tox? https://jeuveau.evolus.com. (Accessed July
2020).
Xeomin. (2020). A uniquely purified choice for frown lines. https://www.xeominaesthetic.com/
professionals/. (Accessed March 2020).
CHAPTER 13
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Return on investment (ROI)
The return on investment (ROI) seems large initially when we pull the
numbers for neuromodulation. An ROI is never as clean cut as it appears
on paper. There are many other factors to consider. It is actually quite a laundry list of additional factors to be considered.
Additional costs
Initial training
Text books
Supplies
alcohol
needles
gloves
Medical license
Continuing education units
Liability insurance
Business owners insurance
Workers comp insurance
Lease or mortgage
Online software for booking
Record keeping
Business license
Electricity
Internet
Staff costs
Consents
Photo storage
Marketing
Legal fees
Locked fridge for product
Website creation
The start up fees can easily be 10,000–20,000 dollars in the first year and
many fees on the list can be re-occurring such as education, insurance, product, supplies, utilities, staff and licensing just to name a few (Table 13.1).
Essentials of Neuromodulation Copyright © 2021 Elsevier Inc.
https://doi.org/10.1016/B978-0-323-89920-8.00023-0 All rights reserved.
245
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Table 13.1 Return on investment (ROI).
Neuromodulation revenue
Clients
per week
Monthly gross
@ $14 per unit
24 units
per client
Monthly net
@ $7.90
24 units
per client
Yearly gross
@ $14 per
unit 24 units
per client
Yearly net
@ $7.90
24 units
per client
1 Client $1344 $758.4 $16,128 $9100.8
2 Clients $2688 $1516.8 $32,256 $18,201.6
3 Clients $4032 $2275.2 $48,384 $27,302.4
5 Clients $6720 $3792 $80,640 $45,504
10 Clients $13,440 $7584 $161,280 $91,008
15 Clients $20,160 11,376 $241,920 $136,512
20 Clients $26,880 $15,168 $322,560 $182,016
CHAPTER 14
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Marketing in esthetics
Marketing
Marketing is a whole separate entity these days with the onslaught of digital
marketing and google ads. Start small and slow, and do not get in over your
head. Interview three or four marketing companies before deciding on
which is best. It is best to scan other esthetic businesses or other businesses;
in general, it does not have to be an esthetic business. Get a sense of the
mood or vibe their online presence has. Deciding early on what colors
and font will be used is a good place to start to begin developing the brand.
It is ideal to figure out what the voice will be in order to be able to relay it to
the marketing team so that they can best create a plan. Finding the voice of
the brand is a struggle for most injectors or business owners. A perfect
balance of confidence and humility needs to be struck. Finding the image
or the online presence can be a challenge as well.
Ultimately, an online presence is the personality of the business. Is the
goal of the brand to be sleek, sexy, or educational? Keeping the personality
of the online presence is important for consumers viewing. Nowadays, the
website and social media platforms are the new door front to a business.
Think of how inviting storefronts can be, especially when the storefront
is all dressed up for the holidays. Often there will be an enticing sign on
the front with a special or a current trend. The physical storefront and
the virtual storefront should have the same feel, message, and level of
warmth. The virtual presence needs to mirror the look and feel when the
client shows up on the doorstep; otherwise, they will feel duped. Marketing
does extend beyond the website. How many times can the injector engage
with their audience without overwhelming them? Scripted emails are helpful to the patients for delivering before and aftercare instructions. This could
be a way you slip in a little incentive as well as a thank you for their loyalty.
Attached are sample emails utilized at DCCM™. Once the patient books an
appointment, the system should automatically send out an email to the
patient based on the appointment type that has been created, along with
an appointment confirmation with the cancelation policy attached. The
email is meant to be informative and help the patient prepare both physically
Essentials of Neuromodulation Copyright © 2021 Elsevier Inc.
https://doi.org/10.1016/B978-0-323-89920-8.00007-2 All rights reserved.
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and emotionally for the visit. After the patient checks out once the service is
complete, they should receive another email thanking them and reminding
them of the aftercare instructions that were in the consent and verbally
reviewed at the visit. These emails; demonstrate to the patient the injector
cares. They also serve as another step to honestly informing the patient so
that consent can truly be accepted. Consent of the patient means nothing
in the absence of information and education.
Examples of pre and post neuromodulation emails
Pre care
Botox pre care guidelines
Please arrive on the day of your appointment with a clean face, free of any
lotions and or makeup, even eye makeup. We recommend showing up
about 10 min prior to your appointment time so that you can fill out your
necessary treatment consents and for us to review your medical history.
After consents are signed, a team member will take your pictures to document the skin’s health and appearance pre-treatment. Once you are
prepped and ready; Tara will begin your treatment, which will take about
10 min.
No dental work within 2 weeks of your treatments.
Bring a hair tie to pull your hair back from your face.
Take Arnica tabs to minimize bruising.
The healthier you eat, the better all-around.
If you feel ill, you must reschedule your appointment.
We look forward to working with you on your esthetic journey.
Want us to let you in on a little secret?
One helpful little trick to improve your Botox (neuromodulator) treatment is being sure you have adequate Zinc in your system. All neuromodulators require Zinc at the nerve terminal so that the neuromodulator can
bind to it most effectively. If you feel that your neuromodulation isn’t as stiff
or strong as it has been in the past and we are using the same dose…consider
adding zinc supplements 5 days prior to treatment and 5 days posttreatment.
Love Tara
Post care
Botox after care instructions
We want to thank you for choosing the team at DCCM™ to help meet your
esthetic goals. Now that you have taken the plunge with your Botox
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(neuromodulator) treatment, we want to remind you about your aftercare
instructions. This way, you can maximize the potential of your treatment.
Please refrain from the use of hats, helmets, and visors, as well as facials
and massages. The Botox (or neuromodulator) that we put in the muscle
needs to set up in the muscle in order to take effect. Restricting blood flow
and putting pressure on the muscles in the treated area can cause an
unwanted shift in the product and sometimes result in an unwanted
outcome.
Botox (neuromodulator) takes 2 full weeks to kick in. As the treatment
begins to settle, you may want to give us a call to have us add a touch more in
that time frame. We will not add more in the treated area within that
2 weeks time frame. Trust in the process that it will all settle out within
2 weeks. Should you need a slight touch up at 2 weeks, we welcome you
to come back in for evaluation. If you would like to add more, we request
that this be done on day 14–19 so that you can get the most out of your
treatment. We honor all of our work, but in order to do so, we require a
follow-up visit on day 14–19 after your initial Botox(neuromodulator)
appointment. Our goal is to do our best to meet your goals. We really
encourage and love to see all of our clients back at 2 weeks to be sure your
treatment is perfect.
If you found yourself with a bit of a bruise, we recommend using Arnica
gel and tablets. Each product formulation is different; therefore, we would
advise you to follow the specific directions on the back of the branded bottle
you purchase. These can be found at the whole foods store right in Hampton
or at most pharmacies and grocery stores.
Want us to let you in on a little secret?
One helpful little trick to improve your Botox (neuromodulator) treatment is ensuring you have adequate Zinc in your system. All neuromodulators require Zinc at the nerve terminal so that the neuromodulator can
bind to it most effectively. If you feel that your neuromodulator is not as
stiff or strong as it has been in the past and we are using the same dose…consider adding zinc supplements 5 days before treatment and 5 days posttreatment.
We want to thank you for choosing the team here at DCCM™.As
always, please call us with any questions or concerns that may arise. We
are here for you and want you to feel confident in the process just as much
as in your skin!
Our number is (603)-783-1087.
Between the hours of 8 a.m. and 4 p.m. you may call the office number.
However, if you feel you have a pressing question that can not wait until
250 Essentials of neuromodulation
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normal business hours; please text (603)-783-1087 so we can assist you. We
hope you enjoy your results and look forward to seeing you again at your
next visit.
Love Tara
In the beginning phases, social media platforms are hard as the injector
does not have many before and after to utilize. The injector is often left purchasing stock photos or creating their own memes. The goal should be to
have as much original content as possible. The trends are currently utilizing
short video clips along with before and after photos of the injectors work.
This particular form of advertising seems to be the most lucrative. Also, do
not be afraid to highlight the investment in the field of esthetics with regard
to the time spent in further education. Show the public and the clients that
growth and training are of the utmost importance to the practice. Blogs
should be done at least monthly, and posts on social platforms should be
daily. It is necessary to understand each platform’s audience can be targeted
with proper marketing messages being delivered. Not every post has to be a
sale and especially not a flash sale. A flash sale is a dead giveaway as an act of
desperation and the need for patients. That should be code for the patients to
run as far away as possible. Better yet, showcase the beautiful work and
illustrate the talent within the hands of the injector. The customers will call
when they are ready to come in.
Forcing them with a deadline and a flash sale can often backfire as those
patients are the impulse buyer instead of the savvy consumer. Esthetic injectables is an expensive industry, and it is, after all their face, so let us not be
pushy better yet, inform the patients while letting them make their own
decision. Educating the patients will yield a happier client in the long
run, most likely a client that will be a repeat customer. The patient relationship needs to be cared for and evolving constantly. A patient should be
looked at as a long-term investment, not a quick grab. There are mixed
opinions on buying followers on social media. The initial focus should be
on organic followers, not purchased followers. Bought followers do not necessarily turn into patients. The goal of growing a practice should not be on
buying followers; rather it should be on developing and maintaining long
standing relationships with patients. Spend money on the existing patients
than buying followers that will likely never be a client. The goal is patients,
not arbitrary followers. With that said, followers are vital as they are the audience for the brand. The focus should be on the quality of followers, not the
quantity. One way to engage the patients and gain more patients is through a
referral program.
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At the end of every checkout process, clients should receive a message of
some sort that lets them know about the referral program. It reminds them
that for every client they refer, they earn $50 off of their next neuromodulation treatment and their friend also receives that discount at their first visit.
Specific criteria for the number of units or even cross-promotions can help
grow the practice organically. The referral program is an opportunity for the
patients to be rewarded for spreading the word about their injector. They
feel appreciated and respected, and more often than not, they are excited
to share with their friends whom they get their esthetic services. The referral
program goes back to the idea of relationships, as well. If the practice is set up
to be a point and click practice, it will likely not have the sustainable relationships necessary for a referral program to work. A referral program works
best with loyal and happy patients. Loyal patients love the service, outcomes
along with their experience with every part of the process of their injections.
Every touchpoint within the practice matters to the esthetic client along
their journey.
Let us get social
Delle Chiaie Cosmetic Medicine DCCM™
Twitter @surfacemed
LinkedIn Delle Chiaie Cosmetic Medicine
IG @DCCM_Tara
FB Delle Chiaie Cosmetic Medicine
Showing the clients that the art and medicine of esthetics are understood is
appreciable to the audience. Find subliminal ways to educate the audience,
so they feel like they learned something. Another way to engage the audience is through questions. Post a fun fact about neuromodulation. Producing fun facts and tidbits demonstrates to the audience that talent and safety
are a priority. Before and after photos are key to the success of a social media
account. Post the work that has consistent lighting and background for the
best engagement.
Relationships in business
We all set out on this voyage of independence thinking we will have freedom form the office politics blazing new paths and making our own rules
while we are the boss. But the reality of it is; even though you may be your
own boss you will still need others. You will need a fellow colleague to help
you through sticky situations or unique patient presentations. The product
representative is a person that you should most certainly develop a
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relationship with. The product reps understand not only their products but
they know their territory and the market demand. They further understand
brand development. The concept of brand development is not just about the
brand they sell, its transferable to your brand as an injector. Relationships in
this industry are essential in terms of success, opportunity and growth. No
matter how proficient you become, there will be a situation where you will
want an extra set of eyes or an opinion on a clinical situation. It may be puzzling as to why a section on relationships is in with marketing. The concept is
simple; cross promotion. Most big companies need the injectors to showcase
their product; so what better way than to network. An injectors before and
after photos can be just the very thing a rep needs to help sell their product or
device. When you reshare injectors share their photos it is branding and
marketing for the practice as well as helping a fellow colleague in the industry. The more closely injectors work with their sales reps the better the success for both individuals. Every relationship is a two way street and it is so
important to help one another out. Both the injector and the sales rep are in
the business of selling, the market is ultimately the same. Develop strong
relationships with the product and device reps as more often than not there
will be a situation where the relationship is mutually fruitful to both parties.
Gone are the days when the drug reps came in and catered lunches. It’s time
now to earn the lunch, with integrity, education, professionals and success.
CHAPTER 15
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Top 10 list for success
in neuromodulation
Top 10 list for success
Setting up a proper consultation to deliver amazing results and ensuring the
client has proper expectations for their neuromodulation treatment.
(1) Be the Expert!
The nurse spent years in school, learning the art of beauty, science,
and medicine. The patient spent hours on google. So when the injector
is fortunate enough to have a client in their exam chair, be sure to educate the patient on anatomy. Also, be sure to teach them about the limitations of the treatment. As unethical as it is, there are still providers
posting before and after photos with filters. The use of filters significantly distorts the reality of outcomes. The injector’s job is to be honest
and set up realistic expectations of the treatment.
A prime example is when the patient has crows feet that extend well
into the mid check beyond the zygoma. The injector will want to educate the patient on where the Botox will be effective and where it will
not be effective. Take the opportunity to talk about resurfacing modalities and or filler if that is the better adjunctive therapy. Most patients
will not understand where Botox can go and can not go. It is also a
common mistake for patients to think that Botox is for wrinkles and
volume loss. They do not understand the anatomy or the products
the way we do. It is our job to educate them. First-time clients should
anticipate being at the visit for 45 min. Take their photos, have them
sign the consent, prep their face, and then plan on 20 min of consult
time and then leave 10 min to treat. Find a graceful and elegant way
to educate the patient to demonstrate expertise in esthetic medicine.
Instilling confidence in the patient about the educational process and
experience the provider has will provide a sense of consumer confidence. The feeling of consumer confidence will be the foundation
to the development of a long term relationship with the patient.
Essentials of Neuromodulation Copyright © 2021 Elsevier Inc.
https://doi.org/10.1016/B978-0-323-89920-8.00031-X All rights reserved.
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