By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

Laser treatments are a staple of the medical aesthetic industry. According to the American Medical Spa Association's (AmSpa's) 2019 Medical Spa State of the Industry Report, laser hair removal is offered by 59% of medical spas, and it is the second-most common procedure for a first-time patient, so it actively brings patients into practices. Additionally, the report found that 29% of medical spas offer full-field ablative laser skin resurfacing. What's more, 8% of medical spas that don't offer laser hair removal and 5% of medical spas that don't offer laser skin resurfacing are considering adding them.

In order to perform any of these laser treatments, however, the proper equipment must be acquired. And that can be more expensive and complicated than one might imagine.

Laser Overview

In recent years, a number of new companies have begun offering laser equipment designed for use by medical aesthetic practices, which has resulted in unprecedented competition. This equipment can be very expensive, costing as much as $250,000, so the stakes in the market are very high.

The representatives who sell this laser equipment typically are compensated, at least partially, on commission, and the commissions they can make are substantial. As is typically the result of commission-based compensation plans, the reps are very motivated to close the deal. Potential clients often forget this fact when they are shopping for a new machine, but savvy consumers always will remember that the sales reps, even at the most reputable companies, make most of their money when they actually sell a machine. Because of this, some reps can be very aggressive.

Although there are many reputable laser companies with very knowledgeable, considerate reps, some other companies employ laser sales reps who act in an unscrupulous manner because of the potential for lucrative commissions. This is the primary reason why you should work with reputable companies with established track records.

Unscrupulous reps often pressure potential customers to make a decision immediately, before they have a chance to truly evaluate their options. These reps will tell customers that they are on a tight timeframe or that they have limited-time discounts that expire soon. However, prospective clients should take a step back and evaluate their options. These are major investments and should be treated with a great deal of care. Good sales reps from trustworthy companies will understand the gravity of the decision and provide customers with the time, information and references they need to make an informed decision.

Prospective customers also should keep in mind that the only time they have leverage in this situation is before the contract is signed—when you can still walk away. This is the time in the process when they must do everything they can to negotiate the deal in their best interest. Therefore, when a representative offers a prospective customer a contract to purchase a laser, that customer must fully understand that contract, because this likely will be the only time that contract can be negotiated.

Preventing Problems

Taking the time to read and understand the contracts offered by the salesperson is the best way for laser customers to protect themselves. If provisions you don't understand are in the contract, ask the sales representative to thoroughly explain them to you. A good rep will always make sure you understand the contract. But it is always a good idea to get an independent explanation. If your lawyer is familiar with negotiating laser contracts, you should consult him or her; if not, you should consider hiring an attorney with knowledge in this area. Laser contracts can be much more complex than contracts for other types of medical aesthetic equipment—they may include convoluted provisions on warranties, maintenance, technical support or authorized use, so enlisting the aid of someone who has experience with them can be tremendously helpful.

The amount of marketing support the manufacturer is offering is an aspect of a laser contract that should be carefully considered. Some laser companies offer excellent support; others say they will but offer nothing in writing to guarantee it. The inclusion of a well-developed marketing assistance program often will increase the price of the laser, but it can add substantial value to the deal. The customer must make sure that the contract he or she signs includes language that guarantees sufficient manufacturer support. With a purchase of this size, it is crucial to the customer to have as much support as possible.

It also is important to ask the representative to provide references from people who own the laser model you are considering purchasing. These should not be clients who just bought the laser and are still in the "honeymoon" period—these should be experienced users who know the highs and lows of owning the laser long term. Or, better yet, ask a group of medical aesthetics professionals you know to ensure you get an honest answer. For example, AmSpa offers a private Facebook group to its members, which acts as a forum for these and any other professional questions that come up in the course of your medical aesthetics business. A prospective buyer should ask about how the laser performs, its service record, its return-on-investment, manufacturer support and any additional relevant information. Good reps will have a large number of references from people they have dealt with throughout the years; if they don't, that should be seen as a red flag.

Deciphering Laser Provisions

Some provisions that prospective customers need to carefully consider are often found in laser contracts. It can take hours to review and analyze all elements of contracts, but there are three provisions that I often focus on when representing clients in laser purchases.

Recertification fees. The most controversial provision deals with recertification fees. It dictates that the manufacturer must inspect a used laser device to "certify" that it is in working order and operating to the manufacturer's standards before it can be resold on the open market. The fee that the manufacturer charges for this service can be quite high—$50,000 or more—and it must be paid before the machine can be supported at a new customer site, which not only cuts into the resale value, but also makes it difficult to resell on the open market. However, some manufacturers provide a warranty and clinical training as part of the recertification fee, which may actually enhance the machine's resale value.

There are valid reasons for having this fee in place—ideally, it helps ensure safety for both patient and provider—but it still is a very significant cost that should be understood before the laser is purchased. This is one reason why it's very important to make sure that the laser you're purchasing can be supported by your market. If, after a few months, you decide that the equipment is not ideal, you might be stuck with an extremely expensive piece of equipment you don't use and can't easily sell— since the secondary market for lasers can be extremely volatile and tends to favor buyers.

Prospective laser buyers should know that they can, in some instances, negotiate recertification fees, and some laser manufacturers are sometimes even willing to waive them altogether, typically when a practice is introducing laser treatments in markets where they have not yet proven to be successful. In fact, some manufacturers will even offer to repurchase the machine after a period of time if customers can show that their market is not responding to the product offerings. However, these are all things that must be negotiated into the contract before the sale is finalized. If the contract is signed and these elements aren't included, you are out of luck.

Resale restriction. A resale restriction dictates that the customer cannot resell a laser without the manufacturer's approval, or that the laser must be sold back to the manufacturer at a discounted price. As with recertification fees, there are valid reasons for these provisions; however, they can limit a practice's options when it purchases new technology. Horror stories abound of medical spas with functional laser technology that they don't use anymore because newer models were released. I've seen practices that have more than $1 million worth of technology sitting in a room gathering dust because they simply can't do anything with them due to contractual restrictions and a weak secondary market.

However, as is the case with recertification fees, a resale restriction can be negotiated. Again, it is extremely important that the customer recognizes these provisions prior to signing the contract in order to maintain leverage. Reputable laser companies stand behind their products and typically have no issues working with new clients to make sure they are satisfied. If nothing else, a good sales rep should explain this provision so that the customer understands why it is there and how it is designed to help the customer.

Service clauses and warranties. Although they are commonly found in medical spas and aesthetic practices, let's not forget that these machines actually fire lasers. This technology was science fiction in the relatively recent past. These are very sophisticated, sensitive pieces of machinery, and no matter how reputable the manufacturer, the machine will need to be serviced at some point. Good companies ensure that the customer endures little downtime and expense in these situations, but it's up to the customer to make sure that everything that needs to be covered is covered for a reasonable amount of time, and that service is guaranteed to occur in a timely manner. After all, every day that the machine is offline is a day it is not generating revenue.

Prospective customers need to learn about exactly what happens if the machine breaks, what is covered—and what is not—under the warranty, and what the included customer support entails. Moreover, they must get as much as possible in writing so that they are guaranteed to have efficient, cost-effective service.

Know What You Don't Know

For a medical aesthetic practice, offering laser treatments can be extremely lucrative, but buying a laser is much more complicated than simply going down to the neighborhood laser store and picking one out. If you know of a lawyer who has experience negotiating laser contracts, it is in your best interest to hire him or her to help negotiate this transaction.