Consider Offering Cosmetic Enhancements

Ophthalmologists are well-suited to provide these procedures.

BY STEVEN YOELIN, M.D.

In the late 1990s, I was functioning as a general ophthalmologist practicing in the Los Angeles metropolitan area, working far too many hours per day and performing a wide variety of ophthalmic procedures. I was also seeking a way to derive more satisfaction and greater remuneration from my ophthalmic practice.

At about that time, a dermatologist friend had launched what soon became a highly successful Botox (Allergan) and fillers-related cosmetic enhancements specialty practice as an adjunct to his dermatology practice. He had quickly generated a substantial and quite impressive patient base for those procedures — patients who primarily came from his existing dermatology practice. He also soon attracted non-dermatology patients who desired to receive cosmetic enhancement treatments.

In addition, my friend quickly found that the many new patients who were initially attracted to cosmetic enhancements were also becoming patients of his dermatology practice.

I was intrigued in regard to the fact that my friend had launched his cosmetic enhancements practice on a one-half day per week basis with virtually no financial investment whatsoever. I was especially surprised by the fact that he eventually became so busy administering Botox and various fillers that he ended up with a very profitable and ongoing 2 full days per week performing cosmetic enhancements.

The bottom line is that providing both dermatology services and cosmetic enhancements proved to be a highly complementary and compatible combination for my friend, resulting in a more rewarding, profitable and satisfying career.

Therefore, I sought his advice, assistance and mentoring in regard to the specific steps that I would need to take in order to emulate his cosmetic enhancements-related success in my own ophthalmic practice. In this article, I will explain how I accomplished that goal.

Patient "Anicka" before (left) and after a Botox treatment by Dr. Yoelin.

Many Initial Questions

Initially, I had numerous questions that I needed my friend to answer, as well as questions that I wanted other qualified people to answer, before I could make a definite commitment to accomplish something meaningful and comparable to what he had accomplished. Among my questions were these:

► Could I follow in my friend's footsteps in regard to launching a cosmetic enhancements-related practice as an adjunct to my own ophthalmic practice, given the fact that I am a general ophthalmologist?

► Exactly which cosmetics procedures could I, and should I, initially offer to my patients?

► How would I obtain the required and specific training that I would need to provide high-quality cosmetic enhancements procedures?

► With which manufacturers and/or distributors would I be dealing, and how much help could they, and would they, extend to me in regard to the launching of my own one-half day per week cosmetic enhancements practice?

► How much time and energy would I need to devote in order to launch and to build this new and additional sector of my ophthalmic practice?

► What additional resources and/or facilities would I need in the way of staffing, office space and new equipment?

► What kind of a very small, or perhaps not so very small, financial commitment would I need to make in regard to the launching and building of this new specialty?

► How would I go about acquiring patients for cosmetic enhancement procedures without causing me to lose my focus in regard to my ophthalmic practice?

► Would I enjoy any significant advantages such as previous training, credentials or credibility with patients as an ophthalmologist who would be performing cosmetic procedures?

► Would significant marketing and/or promotional expenses be involved in my offering of cosmetic enhancements?

With my friend as my mentor and my primary guide, I set out to find the answers to my questions. After I had performed the necessary due diligence, which took several months, I decided to move ahead with the idea.

Starting Out

After thoroughly examining all the issues involved, I made a commitment to become a truly expert provider of Botox as well as several additional FDA-approved dermal fillers.

I initially chose to start out on a small scale, devoting only a half day a week to cosmetic procedures and drawing patients primarily from my own ophthalmic practice in Newport Beach, Calif., and referrals from local aestheticians whom I had informed of my new initiative. This strategy offered the advantage of allowing me to avoid marketing costs while I was determining what the demand would be for cosmetic enhancements services.

I started by offering my ophthalmic patients a variety of elective, non-third-party-payer procedures, such as Botox and dermal-filler injections, which were easy and also enjoyable for me to perform. These treatments were relatively long lasting — but certainly not permanent.

I soon found that the treatments that I offered were definitely in demand, primarily by female patients in their 20s to their 60s and also by many male patients, as I pleasantly and very surprisingly discovered.

I also found that I could provide these treatments at an affordable cost to my patients and that I could do so without the need of offering my patients any financing arrangements at all. I understand that other physicians do offer financing for cosmetic enhancement procedures but it was not something that ever came up in my practice.

From the beginning, it was totally clear to me that benign and consistently favorable outcomes would be extremely important to me and to my patients if I were to attract word-of-mouth referrals to the cosmetic enhancements practice. My ultimate goal was to emulate my dermatologist friend by attracting referral patients for cosmetic procedures and then welcoming these new additions into my ophthalmic practice. With the success of this word-of-mouth strategy, I managed to avoid spending money on expensive advertising and marketing campaigns.

Patient "Krista" before (left) and after a Botox treatment by Dr. Yoelin.

I had spent a good deal of time mastering the proper injection techniques for FDA-approved injectable aesthetic products. Feeling quite comfortable with these products, I decided to stay far away from any and all cosmetic enhancements products not approved for use in the United States. I will also not use cosmetics products that I would need to directly or even indirectly import from any foreign supplier.

The Ophthalmologist Advantage

My background and training as an ophthalmologist was extremely valuable as far as I was concerned, because ophthalmologists are well-trained to be extremely careful and detail-oriented surgeons. Such attributes help to significantly "flatten" the learning curve regarding the use of cosmetic enhancement products.

Most importantly, Botulinum Toxin Type A (Botox) was first used in clinical practice by an ophthalmologist, Alan Scott, M.D., who used it specifically for the treatment of strabismus. In fact, the first two FDA-approved uses for Botox were for strabismus and blepharospasm.

I viewed my cosmetic enhancements practice as an adjunct to my ophthalmic practice and decided to refrain from building a "med spa." Some providers of cosmetics enhancements believe that a spa-like "environment" is necessary to attract an upscale patient base but I found that devoting one room of my office to cosmetics was totally acceptable to my patients. Based upon what I learned from my mentor, I knew that my targeted success did not depend on what I considered superficial amenities that would only increase my overhead and drive up the costs to my cosmetics patients. I believed that I could achieve success if I fully mastered the details related to cosmetic enhancements, while also keeping my overhead extremely low.

In addition to injecting Botox, I soon began to inject additional FDA-approved dermal filler products available to me, such as Restylane (Medicis), Sculptra (Besse Medical), Juvederm (Allergan), Perlane (Sanofi/Aventis) and Radiesse (Bioform).

Approximately 5 years ago, injectables-related manufacturers began asking me to train other physicians in administering their products. They also wanted me to teach strategies for launching and building a successful cosmetic enhancements practice. In that regard, I am now a speaker and also a trainer for several manufacturers that sell FDA-approved cosmetic enhancements products. In addition, I have found the cosmetic enhancements field to be extremely rewarding for a variety of reasons.

For example, I particularly enjoy the creative aspect of my cosmetic enhancements practice. I am certain that given their training, knowledge of facial structure and attention to detail, ophthalmologists are particularly suited to provide these types of procedures. I have attempted to educate as many ophthalmologists in that regard as possible, by speaking at virtually every major ophthalmic meeting regarding proper injection techniques, as well as the very best step-by-step and A-B-C ways for any ophthalmologist to launch, build, operate and enjoy a cosmetic enhancements practice as an adjunct of his or her ophthalmic practice.

Many ophthalmologists have asked me how they can best and most rapidly establish a cosmetic enhancements practice. I always recommend finding an expert mentor who can help you develop an appropriate strategy that will work in your specific area. In other words, model yourself after someone who has already established a successful local cosmetic enhancements-related practice. The initial goal is to master the basics in regard to the easier procedures before moving ahead to administer the more difficult procedures. With the assistance of the various cosmetic enhancements manufacturers, you can secure the exact and specific training that you will need for each product. The manufacturers make such valuable training programs readily available.

Potential Physician Benefits

I made the commitment to offer cosmetic enhancements procedures to my patients only after I knew with certainty exactly what my friend had accomplished in that regard, as well as how he specifically did so, and in a step-by-step manner.

I would like to close by recounting the benefits I have derived as a result of my cosmetic enhancements practice.

► I now enjoy an extremely diversified and significantly improved income stream, over and above my therapeutic ophthalmic activities, and my fees in that regard are not dictated by insurance companies or the government.

► My cosmetic enhancements-related services never require me to deal with any accounts receivable issues whatsoever because, as with any elective procedure, my patients pay me on a "fee for service" basis.

► As opposed to so many procedures within the field of ophthalmology, including cataract and refractive surgery, where a single procedure usually solves the patient's problem, my cosmetic enhancements practice calls for patients to return two to three times per year to maintain a very specific level of correction and perfection. I never need to ask any of my patients to return for any additional cosmetic treatments because they schedule additional treatments on their own.

► I have avoided all malpractice issues because I have always focused on generating patient-pleasing outcomes. I use a step-by-step procedure to make absolutely sure that all of my patients are totally happy and satisfied with the outcome that they receive.

► I utilize just one part-time office receptionist to help manage my cosmetic enhancements practice. My low-over-head approach has proved to be the right way for me way to accomplish the original objectives that I long had in mind.

► The most enjoyable part of my cosmetic practice relates to my ability to explore the creative aspects of the medical field. The creative stimulation of a cosmetic enhancements practice can complement the more traditional procedures that most ophthalmologists practice.

► As neurotoxins such as Botox and various dermal fillers become more well accepted for use within our society, the demand for qualified practitioners will be far more intense than it already is. My office cosmetic enhancements telephone lines are busy all day with patients calling to make appointments for the next 90 days. I also enjoy a huge waiting list of people who want to receive a treatment when a scheduled patient cancels an appointment, which effectively eliminates any gaps in my schedule. The same situation exists on a month-by-month basis, in that my targeted 90-day schedule is always totally filled. OM

Steven Yoelin, M.D., practices in Newport Beach, Calif. He has professional and/or business relationships with Allergan, Bioform, Medicis, Sanofi Aventis and ColBar. He will answer any questions concerning this article if an e-mail communication is sent to him at steveyoelinmd@aol.com.