Under Sientra’s management, the new miraDry is on a mission to make sweat the new fat 

HEADQUARTERED IN SANTA CLARA, CA, Miramar Labs® is a global medical device company that introduced the miraDry® System in 2012 as the only FDA cleared device to reduce underarm sweat, odour and permanently reduce hair of all colours. In 2017, Sientra®, in Santa Barbara, CA added miraDry to its aesthetic portfolio that includes breast implants and breast tissue expanders marketed exclusively to board-certified and board-admissible plastic surgeons, as well as a range of other products including BIOCORNEUM® scar management.

Aesthetic industry veteran Keith Sullivan was invited by Chairman and CEO Jeffrey Nugent to join Sientra initially as a board member, and subsequently as the interim general manager of miraDry in early 2017. ‘At that time Sientra was coming out of a very tough period, their supplier had a plant that burned down. They had lost most of their customers and had a limited supply of breast implants, so they had to build their own plant in Wisconsin, go through the FDA clearance process and into production which took about two and half years. Jeff asked me to join the board to offer a different perspective on their business. I was honoured by his invitation. At the same time, he was looking at miraDry to add to their portfolio so they weren’t so dependent upon the breast business, and asked for my help,’ says Mr. Sullivan.

As he was doing due diligence on miraDry, Mr. Sullivan recognised that it came down to three things. ‘It was either an execution problem, a product problem or a market problem and I had to determine whether it was one or several of those. The product was solid and there were two consistent things physicians told us. First, that the technology works on everybody, and 100% of the patients were thrilled with it. The second thing was that no one was asking for it. So, it was clearly not a product problem. Next, I had to determine whether it was an execution problem or a market problem,’ he says.

‘It became clear that it was an execution problem and less of a market problem, so we looked at the protocol and how we deployed miraDry in a physician’s office. My 35 years of experience told me that practitioners would prefer a less invasive treatment to be as simple as possible, and to delegate the treatment to a qualified staff member if possible, to focus on other procedures,’ says Mr. Sullivan. Among the improvements they made was to institute a simpler, more elegant and controllable way to provide local anaesthesia that feels like a single needle stick and enables the practitioner to deploy a lidocaine mix in a matter of seconds, so the patient was very comfortable.

Another advance they added was to shorten the treatment time by reducing the time required for cooling each site and making it more predictable and controllable. ‘Those two things were easily fixed in the system to make the treatment more appealing to physicians and the net result was that we were able to take this treatment from about an hour down to thirty to fifty minutes. We made it simpler for staff to do in under an hour,’ says Mr. Sullivan.

The sweat market

The Sientra miraDry team set out to determine the size of the market and narrow down who the target market was. ‘We wanted to know the age group that comprised the market, what resonates with them and how to reach them. The data that came back was a surprise to us. The previous miraDry regime had targeted a group of 6 to 9 million baby boomers of 45-65 year old who were suffering from hyperhidrosis and were clinically diagnosed. This group actually turned out to be 15 million, which is almost double the size,’ says Mr. Sullivan.

They also looked into another group of patients who are ‘sweat bothered’ which is about 22 million strong. ‘These people are not clinically diagnosed, but they suffer from sweating in social or business situations that they can’t control. In total, the market we identified is 37.3 million people. Most people envision a big heavy hairy guy as being the person that suffers from hyperhidrosis or excessive sweat, but our research shows that 66% are actually women. The other surprising finding was that 76% of the people in our target audience are millennials between the ages of 18–44,’ he says.

We all know that millennials get their information on their devices, so Mr. Sullivan and his team focused their marketing campaign around Google ad words, digital and social media to get on their radar. They also learned that 86% of the target audience have never been to an aesthetic dermatologist or plastic surgeon. ‘So, when our physicians say I love it, it works on everyone, but nobody asks for it, it’s because these patients are not in their practices. Those three stats, 66% women, 76% millennials, 86% have never been to an aesthetic practice, gave us an opportunity to zero in on that market,’ he says.

According to Mr. Sullivan, Marina Del Rey, CA plastic surgeon Grant Stevens did a study at his own practice and found that if he can bring a patient into his practice that was in their 30s or 40, they were worth about $100,000 over the course of their lifetime. ‘miraDry offers the same opportunity. If we can get these patients to be treated at an aesthetic physician’s office, dermatologist, plastic surgeon or aesthetic doctor and we solve their problem and treat them well, the value of that patient for the rest of their lives can be huge,’ he says.

The practice of miraDry

Over the years, the miraDry model has had its share of success stories among many practices who have figured out how to integrate it into their treatment menu. According to New York City plastic surgeon Sachin Sridiani, MD, ‘The addition of miraDry to my practice 3 years ago was a calculated decision to add a device that was not as well known, but that I knew would be impactful. I recognised that a different subset of the population could be helped but may not be seeking treatments for sweat. The majority of our patients undergoing miraDry are not hyperhidrosis patients, but rather patients interested in wellness. They eat organic, work out routinely, care about their bodies and do not want to put harsh chemicals on their bodies on a daily basis to temporarily alleviate sweating and mask odour. They aren’t stinky and sweaty people, just everyday people that realise that they don’t have to use antiperspirants and deodorants every day for the rest of their lives. The device has made good business sense and recuperation of capital investment was not particularly challenging.’

In addition, according to Dr. Sridiani, patient satisfaction is exceedingly high. ‘Hyperhidrosis patients find the treatment to be life-changing. Lifestyle-oriented patients find it to be liberating to not worry about unnecessary axillary sweating and odour,’ he says.

Plastic surgeon Jennifer Harrington of Plymouth, MN introduced miraDry in early 2018 for a new space she built out. ‘I vetted it hard, and when I found out it was the real deal, I grabbed it. We have also incorporated it into our surgical menu. Adding it to a surgical procedure makes perfect sense. This device is delegatable, so the treatment is performed by a nurse or PA while I’m able to accomplish other tasks,’ she says.

‘Everyone sweats to different degrees and for most, controlling it, or lack thereof, seriously impacts their day-to-day lives — job performance, confidence, and relationships. We have found that starting from an educational standpoint and introducing the treatment as a measurable, permanent option for people, the conversation is actually initiated by our audience. We perform consultations with the machine right in the room because it is such a sleek device, and not intimidating at all. We ask the questions that really help patients understand that, truthfully, everyone can use this treatment. The hyperhidrosis patient is a given, but from the single millennial, business executive, teachers and speakers who go in front of audiences, to the chemical-conscious patient, literally everyone is a candidate to benefit from miraDry,’ she adds.

Miradry has also had great success with their global expansion. At KLNIK in Cheshire UK, Doctor Roshan Ravindran explains how miraDry has fit into his busy aesthetic clinic; ‘miraDry has proven to be a revolutionary and life changing treatment for my patients, providing a permanent solution for unwanted sweating. It’s vital to me to have the world’s best technology, and miraDry is a safe, clinically proven FDA, CE marked and non-invasive treatment that has immediate results. It isn’t just a treatment for sufferers of hyperhidrosis, but a treatment for anyone who has sweating they would like to combat or users of deodorant. miraDry is a remarkable treatment that has restored my patients’ confidence and improved their overall quality of life in just one 30-minute session.’

Aesthetic Doctor Patrick Treacy of Ailesbury Clinics in Dublin, Cork and Galway, Ireland notes, ‘The miraDry quick office procedure permanently eradicates sweating. Consequently it has changed many of my patients’ lives by giving them back full control of otherwise potentially embarrassing social situations.’

The miraDry investment

Like most practitioners today, every discussion about capital equipment begins and ends with how soon she can meet her ROI, says Dr. Harrington. ‘It is one of my metrics for evaluating the investment opportunity. Although the question has merit with this device, there is another metric to consider — patient lifetime value. While every device in my clinic has a patient target age of 40s and up, 60–70% of miraDry patients are in the millennial and generation-Z demographic. That means that my clinic is seeing patients in their 20s come in and get a proven, reliable treatment with miraDry so I’m building trust with those clients. Where will they go when they want Botox®, fillers, CoolSculpting®, Viveve®, etc.? You guessed it — to me. The value of this 20-something patient to me represents a more important metric than ROI, and it is specific to miraDry,’ she says.

‘Miradry is the only treatment that offers a lifetime of freedom from underarm sweat and odour. My patients are thrilled with their results and only wish that they had done it sooner. Hands down, it has been a great investment for my practice. It introduces new patients into their practices which in turn, introduces them to all of the other services they offer, both surgical and non-surgical,’ say Dr. Harrington.

Plastic surgeon Cynthia Diehl in Raleigh, NC has a room completely dedicated to miraDry, which allows her to control the environment and make it as relaxing as possible. ‘Anything that would provoke anxiety is tucked out of sight in the furniture piece. When miraDry patients come in for a consult and tour the office, the treatment room is warm and welcoming. We appreciate the anxiety associated with each procedure and take that element out of the equation as much as possible.’ She says.

In her practice, the main miraDry provider is an RN. ‘With the new syringe adapter she is very comfortable numbing and then treating the patient. I do not have to be involved in the procedure at all, freeing me up to see new patients or be in the operating room. This has made the miraDry procedure delegatable to a nurse provider and is therefore a true passive income stream in my office,’ she says.

‘Seventy-five percent of our miraDry patients are brand new to my practice, with 30% being males. Because miraDry performs so beautifully, these are some of my happiest patients. Not only does the high patient satisfaction entice them to consider other treatments, making them a loyal patient, but they refer friends, colleagues and family members for all of the procedures we offer, not only miraDry. They have had such a great experience in our office from the treatment to the result that if anyone asks about plastic surgery, my name is on the tip of their tongue. They send their wives and husbands in for CoolSculpting, liposuction, and breast augmentation. miraDry has been an important component to building my aesthetic practice. One of the best things about miraDry is that these patients are so grateful, they write unsolicited reviews about our practice,’ says Dr. Diehl.

Future innovations

Now that Mr. Sullivan and his team have figured out the secret sauce of taking miraDry to the next level, they are excited about the future of this unique brand.

‘Our playbook is that we are going after younger patients to connect with them in different ways, so we are focusing our practice development team in to teach our customers how to buy Google ad words, how to interface with Facebook and Instagram,’ he says. ‘The miraDry team, both US and international is second-to-none. There has been a huge uptick in direct-to-consumer marketing and investment in practice support. The miraDry fresh protocols and miraDry freshnet online portal are direct results of Sientra’s investment and commitment to growing this technology and supporting their physician users. I couldn’t be happier with this acquisition,’ says Dr. Harrington.

Miradry is planning to advance the technology further and they are looking at expanding to treat additional body areas. They are targeting the back, chest and groin which are areas where people tend to sweat more, and can be troublesome and uncomfortable, according to Mr. Sullivan. ‘We already know that there is also an opportunity to use miraDry as a hair removal treatment. We have approval for hair removal under the arms which is a byproduct of getting treated for sweat. We also believe that we can help patients with excessive hair growth on their chest and back and be able to remove a good percentage of unwanted hair in one or two treatments. That is our outlook for miraDry over the next few years. It’s pretty exciting and we have a great opportunity ahead of us,’ he says. 

Find out more at: MIRADRY.COM