By Madilyn Moeller, Editorial Assistant, American Med Spa Association

Saline in medical spas is frequently used to reconstitute drugs, deliver IV medication and perform other daily operations. Recently, medical spa owners have reported having difficulty accessing bacteriostatic saline. In the absence of that crucial medical supply, some medical spas have tried to procure normal saline, only to find it is similarly in short supply.

These problems have been a few years in the making. COVID-19 has stressed the country's stores of medical supplies with the increased need for personal protective equipment (PPE)—masks, gowns, gloves, etc.—ventilators, hospital beds and healthy medical personnel. The production of vaccines put additional strain on saline usage and diverted the resources of key manufacturers. Medical spas have had to use vials and bags of saline as necessary in place of pre-filled syringes. Now, the invasion of Ukraine has created supply concerns that affect not only the medical supplies, but also the materials and fuel needed to produce and ship the components.

The U.S. Food and Drug Administration (FDA) lists saline among the medical device shortages, as of March 1, 2022. The administration published the following recommendations on March 21 for health care personnel to follow when prefilled 0.9% sodium chloride lock/flush syringes are not available:

• "Use preservative-free, sterile 0.9% sodium chloride single dose vials if prefilled sterile 0.9% sodium chloride syringes are unavailable.
  
• "Use heparin lock flush syringes, typically used to flush an IV catheter to help prevent blockage within the catheter after receiving an IV infusion, if medically appropriate and in accordance with your facility's policy, unless contraindicated in the manufacturer's labeling.
  
• "Do not use expired prefilled saline flush syringes because they may have decreased volume, degraded ingredients, or lack sterility that may compromise the device's performance and increase patient risk.
  
• "Do not use prefilled saline flush syringes that are not FDA-cleared flush syringes.
  
• "Contact the FDA at deviceshortages@fda.hhs.gov as well as your group purchasing organization (GPO), local product representative, distributor, or account manager if the conservation strategies are not adequate to maintain sufficient supply.
  
• "Consider recommendations from the FDA as well as relevant professional organizations for other strategies that might be appropriate for your organization."
  

If all goes well, these recommendations can help your medical spa manage until supply is restored.

As many news organizations have noted, the demand for medical aesthetics has grown since practices were first allowed to reopen early on in the pandemic. The balance between a strain on supply and the need to meet an increased demand is creating a challenge for medical spa practice managers. To face current and future shortages, your medical spa should learn supply chain management techniques adapted for your business.

Stockout Is Bad for Business

Stockout, the term for when inventory of a certain item is exhausted, can hurt your medical spa's operations. While the term fits most closely with businesses that sell a product, it applies in this context. When a medical spa has difficulty accessing the drugs and medical supplies needed to perform treatments, it cannot meet client demand and will likely lose revenue from the inability to provide services. Your clients may become disappointed and turn to a competitor for treatment, impacting future profits.

The following are general strategies your medical spa can adopt when you are up against shortages.

When you are running low:

• Contact your supplier.
  
• Do your research. Make some calls to see if any other suppliers have stock available.
  
• Reach out to your network. Ask if anyone has a supplier with the product in stock or has some to spare if you are in dire need.
  
• Seek alternatives.
  
• Consider temporarily increasing the price to temper demand.
  
• Hold on to three to five percent of your inventory.
  

When you have officially run out of product:

• Expedite stock replacement and additional inventory (emergency for next time).
  
• Shift to different treatment modalities.
  
• Halt marketing of products or treatments that require the product.
  
• Be clear and honest with your customers about the inconvenience.
  
• Re-evaluate your inventory needs and create a plan for next time.
  
• Once you have stock again, promote it to boost demand and make up for lost revenue.
  

When Aesthetic Products Are Backordered

When you don't have access to a brand-name prescription drug, you may be able to replicate the effects of an aesthetic product through drug compounding. Compounded drugs are made from two or more ingredients that have been combined, mixed or altered by the compounding pharmacy. Importantly, however, compounding drugs are not approved by the U.S. Food and Drug Administration (FDA).

Drugs can be compounded by licensed pharmacists in a state-licensed pharmacy or federal facility, or by a physician; otherwise, you can purchase these products from designated facilities. Compounding pharmacies are referred to as outsourcing facilities. The drugs made in these facilities must meet current good manufacturing practice requirements. A facility that is registered under section 503B of the Federal Food, Drug, and Cosmetic (FD&C) Act is overseen by the FDA. Your state regulations may vary regarding ordering compounded prescription drugs. To learn about rules for ordering compounded drugs in your state, contact a local attorney familiar with these requirements.

Alternatively, when you are having difficulty accessing a certain product, you might need to find a solution using the devices and products you have in stock. Sometimes, products can be substituted for one another with some alteration. A hyperdilute calcium hydroxylapatite (CaHA) solution can be used for skin tightening in place of other treatment therapies, such as poly-L-lactic acid, when supplies are limited. These alternate treatment options can be useful for patients with sensitive skin that would make treatment from energy-based devices uncomfortable, or for patients who cannot undergo radiofrequency treatment because of metal implants, for example. If you run out of deoxycholic acid, you can turn to a radiofrequency, body-sculpting or other energy-based device to target submental fat. Combining treatment modalities—in separate treatment sessions—can help you achieve even stronger results. Confer with other experienced medical aesthetic professionals to find a safe and effective solution with the supplies you have available.

You could also use a product shortage as an opportunity to promote treatments from other devices in your practice. If you are low on injectables, now might be the time to address a patient's skin care needs or body contouring wishes. Pivot to make use of the technology that is still available while taking care of your patient's concerns.

How Much Do You Need to Keep in Stock?

Forecast your future demand based on your medical spa's historical sales data and market trends, leaving wiggle room. If you have a forecasting tool, use a stochastic forecast to anticipate your future demand with range for uncertainty. This type of projection will help you view multiple outcomes and plan for the optimal inventory targets. Tracking your short-term demand can help when your product has a shorter shelf life.

Keep track of your supplier's lead time. This is the time between placing the order and receiving the products. You need to factor this in when you calculate when to reorder.

Know how much to order at once. Use this formula as a guide for managing your supply and make alterations based on seasonal demand, the shelf life of these products, and your supplier's order restrictions.

Total Days = Days of supply you want on hand + lead time + buffer days

Order Size = (Daily product usage x Total Days) – current supply

You know it is time to reorder product when you reach your minimum desired supply level. Set that number based on your product usage for the number of days you have in mind, factoring in lead time.

Staying Ahead of Supply Chain Issues

Solo providers or medical spas that are newly opened or have small budgets might begin by keeping only what they will need for a week or so; single-chair injectors starting out have been known to do this. While this strategy can work in the short term, choosing to keep a low supply can quickly put a stop to business if a single element in the supply chain malfunctions, especially in the event of a shortage. To confidently invest in a larger supply of product, your medical spa can implement some of the following solutions.

First, track your inventory regularly. This is vital to maintaining your operations and knowing when to reorder.

Some in medical aesthetics have adopted supply protection through pooling resources. Here's an example: Injections of hyaluronic acid come with the potential for complications, but, luckily, this ingredient is dissolvable with hyaluronidase. Each medical spa that injects with this dermal filler should have hyaluronidase in its safety kit, along with the accompanying protocol. However, the amount of hyaluronidase needed can vary case by case—providers flood the affected area. Medical spas in the same region sometimes come together to make sure adverse events from hyaluronic acid injection can be swiftly treated by coordinating with each other over their respective stores of hyaluronidase. They share information about exactly how many vials each medical spa has, so in the event of an emergency, the practices can contact each other to access more if their own supply is insufficient. Pooling resources can also prevent any one medical spa from hoarding resources thanks to that safety in cooperation.

Sourcing from more than one supplier is a standard solution to supply issues. Whether it's for your PPE, saline, injectables or other products, having the flexibility to work with more than one vendor for comparable products increases your ability to adjust with shifts in supply.

In health care, practices can order supplies with other practices through group purchasing organizations (GPOs) to increase their purchasing power and receive lower group rates. The GPO contracts with vendors and orchestrates the logistics of securing products. Joining a GPO can make the process of purchasing gloves, needles, and other daily equipment easier for your medical spa.

Anticipate future bottlenecks to prepare your medical spa for later disturbances. According to Harvard Business Review, identifying bottlenecks "requires excellent information about the inventory available in the entire supply chain (not just one's own inventory), the capacity of suppliers, demand patterns, and rates of consumption."

Understanding the interplay between your usage rates, client demand, current stock levels, the product's shelf life, and your supplier's lead time can help you to manage your supply.

To learn from the experiences of other medical aesthetic professionals, access the private AmSpa Member Lounge on Facebook.