LAS VEGAS Before investing in a laser, take patient demographics into consideration, suggested Dr. Arielle N.B. Kauvar.

For example, for practices with a large number of patients with acne and rosacea, intense pulsed light (IPL) devices, pulsed dye lasers, or potassium-titanyl-phosphate (KTP) lasers would be good choices. "With all three of these, you can also treat pigmented lesions, so you'd have some versatility," Dr. Kauvar said at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

IPL also can be used for hair removal, but for rosacea patients it may require more treatment sessions for individuals with discrete telangiectasia, said Dr. Kauvar, a dermatologist who practices in New York. Pulsed dye lasers also can be used to treat vascular birthmarks and hypertrophic scars.

For practices with a large number of patients asking for tattoo removal as well as rejuvenation, she recommends Q-switched lasers plus another device. "To effectively treat tattoos, you need three wavelengths," she said. "So you need to have one device that has all three wavelengths or you have to purchase two different lasers. Then you'll need a separate device for rejuvenation."

After a device has been selected, the new procedures will have to be accommodated into the work flow. If you currently have a busy medical dermatology practice, "you need to think about scheduling these patients at a different time," Dr. Kauvar said. "If you are already performing some type of cosmetic procedure such as injectables, liposuction, or sclerotherapy, you are at a distinct advantage because most patients seeking one cosmetic procedure will be interested in others as well."

She discussed other points to consider before purchasing a laser:

▸ Recognize patient needs. To determine what devices would be most appropriate, consider asking patients to fill out an office questionnaire to get a sense of treatments that interest them. Provide them with a list of common treatments "because they may not know that their problem is treatable," she noted. "Ask them to prioritize their list, and get some idea of what they would be willing to pay for a procedure or for a series of treatments."

When the day comes to add a new procedure, discount the initial treatments. This "allows you to develop experience with the procedure and it also provides you with feedback from your patients," she said.

▸ Set a monthly budget. Individual devices can cost up to $150,000. Most clinicians lease their equipment for 35 years, but month-to-month rental is another option. "You need to figure out how many procedures you have to perform to break even with each device that you add to your practice," Dr. Kauvar advised.

Renting a laser provides an opportunity to try it without a long-term commitment, but the rental costs are steepusually $1,000/day per laser.

On the other hand, a 3-year lease on a $100,000 laser would cost about $3,000/month, while a 2-year lease on that same unit would cost about $2,000/month. "This monthly lease amount will vary to some degree depending on your termination options," she said. Leasing may provide a tax advantage in the form of depreciation of the equipment, but it also poses certain disadvantages, including a long-term financial commitment and the fact that technology evolves quickly.

Other costs to consider before buying a laser include maintenance contracts, which are "almost always advisable," said Dr. Kauvar, also of the department of dermatology at New York University. "Typically they come with 1- to 3-year warranties. But once the warranty expires, you will probably have to pay somewhere on the order of $5,000$10,000/laser per year for a maintenance contract. You have to factor that into the cost of the device."

Maintenance contracts are important, "because these are fragile pieces of equipment, and they do break down."

Other hidden costs include items such as laser or device tips, replacement heads for IPL devices, cryogen, marketing materials in the form of brochures and advertisements, and possible installation of a dedicated high-voltage line. "You also need to assess your ventilation needs, because many of these lasers and devices generate a lot of heat output," she noted.

▸ Get training. Seek out appropriate training in laser safety and laser-tissue interactions, "not only didactic training sessions but hands-on laser training sessions for techniques and procedures," Dr. Kauvar said. "You have to absolutely understand what you're doing to the skin."

She also warned against delegating these procedures to untrained staff. "They're not cookbook procedures," she said. "When these lasers and devices are used inappropriately, they can lead to long-term dyspigmentation and scarring."

Dr. Kauvar disclosed having no relevant conflicts of interest.

Consider Patient Demographics Before Purchasing a Laser