Douglas L. Weed, DC
Part One of Two Parts
As chiropractors continue to feel the squeeze of diminishing insurance reimbursement on their bottom line, many search for ethical, complementary revenue streams to enhance their income. An excellent revenue source to consider that offers a close fit with the "natural healing profession" for which chiropractic is known, is body sculpting, or targeted inch loss using infrared light.
Body sculpting is a non-invasive therapy, using light sources already familiar to chiropractors; is safe and effective; requires a small one-time investment; does not require use of consumables; and is a simply applied, 20-minute unattended therapy. Properly marketed, advertising costs may be minimized. A single, under-utilized room is all that is required. Associated fixed and variable overhead costs are therefore minimal, all of which amounts to an investment with an excellent rate of return. Body sculpting lends itself to offering patients other services as added revenue sources, including ancillary therapies that increase results, weight-loss and exercise programs, and nutraceuticals to improve results.
When adding a "niche market" therapy, a major consideration should be the size of the market. Perhaps the largest and ever growing (no pun intended) market is the overweight and obese population, which currently constitutes 65% of Americans. It is estimated that if current trends continue, 80% of our population will be in this category by 2030.
Infrared and Lasers
Obviously, light therapy has been used for many years in various forms. In the last few years, infrared light of a specific frequency in the 635-650nm range has been found to cause targeted loss of fat from adipocytes by disrupting the cell membrane, therefore allowing for the escape of triglycerides, free-fatty acids and glycerol contained with in fat cells, without causing damage or apoptosis.
Two types of body sculpting tools have been developed; one using laser light, the other, non-coherent infrared light of a similar wavelength created by Light Emitting Diodes (LED's). The laser devices are considered to be "cold lasers" as they are non-ablative. They do require FDA approval, as they are medical devices. On the other hand, the LED units are generally not classified as medical devices and FDA approval is not mandated.
Thousands of articles have been written in the past 30 years on the use of laser and infrared light. The phenomena of "biostimulation" or "photobiomodulation," have established the benefits of infrared light of varying wavelengths on pain reduction and improvements in healing that occurs at the cellular level1. A 2008 study showed that low-level laser light opened "pores" in adipocytes membranes that allowed for escape of fat products without damaging the cell.2 Another 2010 study with 130 people using low-level laser therapy who completed either 6 or 12 sessions, showed that they lost an average 6.55cm and 11.04cm respectively from the torso. If they concurrently lost weight, the results increased to 9 and 16cm respectively.3 A study performed in 2002 using low-level laser-assisted lipoplasty, showed that 99% of adipocytes irradiated for six minutes with 635nm cold laser light had a transitory disruption of the cell membrane, as shown by SEM and TEM.4
After researching both LED and laser devices, it does not appear to me that there is a clear cut difference in results obtained by either. The Karu study reference above1 concluded, "Coherent (i.e.laser), properties of laser light are not manifested at the molecular level by light interaction with biotissue ... At the cellular level, biological responses are determined by absorption of light with photoreceptor molecules. Coherent properties of laser light are unimportant ... some additional effects…can occur only in deeper layers of bulk tissue."
[pb]We started using a "cold laser" two years ago in my practice. When we grew to the point where a second unit was needed, I purchased an infrared LED unit. Both yield results. Our statistics give an edge to the infrared unit. The probable reason for this is that this unit has 16 treatment pads, consisting of 30 diodes each, which at maximum output provide about 14mw of energy each. The cold laser, on the other hand, only has two treatment paddles with 8-10mw diodes each. The infrared unit affords about eight times the area covered with over 30 times the total energy input. Even assuming equal results, the infrared unit has my recommendation, as it is substantially less expensive to purchase.
Our statistics show that measurable circumferential reduction occurs in the vast majority of our patients. We measure the abdomen at the umbilicus, 2" above and below. When we summate the inch loss from these three areas we have obtained results similar to the above referenced study.
The patient benefits when we can set reasonable treatment goals and achieve those goals. A series of treatments frequently acts as a motivating factor to "jump-start" a weight loss and health improvement program (additional services that may be offered through your office). Done properly, there will be a high degree of patient satisfaction. (Our practice has a 5-star Yelp rating).
The practice benefits in numerous ways. Diversification of income streams, additional patient inflow creating other income opportunities and supplemental incomes are some of the benefits. Our practice generated more than $250,000 in 2012 from income derived from body sculpting and ancillary services, while changing rates that are often less than half of what non-chiropractor providers of similar services charge.
Whereas training on the mechanical aspects of treatment is straightforward for any chiropractor accustomed to the use of physical modalities and procedures; creating a business is more complex than simply purchasing a unit, plugging it in and starting to treat patients. Two years of experience has shown that there are many intricacies in the appropriate selection of patients, setting of realistic goals, making recommendations for other services, sales and marketing and a host of other items that go into creating a successful business. Proper intake and management forms are required. Program sales are an art form that needs to be perfected. Successful marketing without wasting thousands of dollars is critical to success. Training by a successful doctor experienced in body sculpting is highly recommended to ensure success of your new venture.
In conclusion, substantial economic benefit may be derived by adding body sculpting and other associated revenue sources to your practice. Use of infrared light is a proven technology to affect circumferential reduction; the effects of which are enhanced by concurrent weight loss. An infrared diode unit may be superior to laser diodes for start-up cost, results and patient satisfaction. Properly performed, the high degree of patient satisfaction can further promote your business, while adding significantly to your bottom line.
Editor's Note: In Part 2, Dr. Weed will discuss the specifics of how body sculpting and it's associated ancillary services can substantially increase your practice.
References:
- Low-Power Laser Therapy, Chapter 48. Tiina I. Karu, Institute of Laser and Information Technologies; Russian Academy of Sciences, Troitsk, Moscow Region, Russian Federation.
- Mechanistic Studies for Local Fat Reduction, Caruso-Davis M, Guillot T, Yu Y, Mashtalir N, Bissoon L, Dhurandhar N, Greenway F. Published in Obesity Journal 16(suppl. 1):S161, 2008. Presented at NAASO Annual Scientific Meeting, Phoenix, Arizona. October 3-7, 2008.
- Effects of Low-level Laser Therapy in Subcutaneous Fat Reduction and Improvement in Body Contour, Vinod Podichetty MD, Daniel Bourassa, DC. Presented at ASLMS 30th Annual Conference Phoenix, Arizona, April 14-18, 2011.
- Fat Liquefaction: Effect of Low-Level Laser Energy on Adipose Tissue, Rodrigo Neira, M.D., José Arroyave, B.S.C.E., T.E.M., S.E.M., Hugo Ramirez, M.V., Clara LucÃa Ortiz, M.D., Efrain Solarte, Dr. rer. nat., Federico Sequeda, Ph.D., and Maria Isabel Gutierrez, M.D., M.Sc., Ph.D.
