Adding Oculoplastics: The Good, the Bad and the Beautiful

How we added this lucrative specialty to our practice.

BY JOHN H. ZEITER, MD

Medi spa, Med spa, Skin and Laser Center, Laser Skin Rejuvenation Center, Laser Hair Removal, Skin Rejuvenation and Resurfacing: What do these cosmetic centers have in common? Other than Botox at $8 a unit and more specials than JC Penney (before the new CEO took over), these “spas” can offer any number of additional services and products.

Moreover, they can be owned and operated by dermatologists, plastic surgeons, ophthalmologists, family practitioners or any other medical specialist, for that matter. This is not the type of oculoplastic practice that my partners and I envisioned when we first decided to recruit a fellowship-trained oculoplastic surgeon. Although our newly built Oculofacial Plastic Center does offer many ancillary cosmetic services and includes an aesthetician, our primary focus remains in treating patients with functional eyelid problems, nasolacrymal disorders and orbital pathology. Here’s our story of how we created a successful cosmetic surgery center while still keeping the focus on where we feel most comfortable — the medical side.

Out of Necessity

Our practice is located in the agricultural mecca of northern California, the San Joaquin Valley. Because of the rural nature of our community, the nearest oculoplastic specialists are in Sacramento, San Francisco and Fresno — all more than an hour’s drive for our patients. For this reason, my partner and I began performing eyelid surgery early in our careers. As our practice grew, including two more partners and four additional offices, so did our oculoplastic practice. Several years ago, we made the inevitable decision to recruit an oculofacial plastic specialist so we could better focus on the exciting advancements in cataract surgery.

Although I’m sure it is possible for a large multispecialty ophthalmology practice to start an oculofacial plastic practice from scratch, I have to believe that supporting a new associate is much easier when a practice already has a reputation for performing eyelid surgery and has an existing base of referring doctors and patients. Such was the case with our practice. Our new surgeon, fellowship-trained through the American Society of Ophthalmic Plastic and Reconstructive Surgery, was busy from her first day. This sounds like a great scenario, except that finding time and space in a multi-office practice with five busy ophthalmologists and four optometrists became almost an immediate challenge.

And, if one has any desire at all to grow a “cosmetic” business, then herding plastics patients into general ophthalmology clinics is not the way to go. It’s no different than trying to see LASIK or premium IOL consults between a full schedule of dry eye and conjunctivitis patients. Thus came the idea of building a separate oculofacial plastics, reconstructive surgery and cosmetic skin care office.

The Right Environment

Having already designed and built three offices and a free-standing ASC, we were familiar with the local real estate market, architects and contractors. Finding and purchasing a suitable space for our oculoplastics center, then, was not difficult. We anticipated that designing a medical office to accommodate and attract a specific group of patients, namely oculofacial plastic patients with either functional or cosmetic issues, was going to be challenging. As it turned out, with the help of an excellent local architect and design team, this office was the most straightforward and enjoyable build-out we’ve completed — a dream compared to the regulatory nightmares of building an ASC.

We started with a floor plan that included a spacious, somewhat luxurious waiting room (Figure 1); upscale patient restrooms; four exam lanes; an aesthetician/skin product room (Figure 2); a large minor procedure/skin laser room (Figure 3); a surgery scheduling room; and finally, the staff bathroom, break room and doctor’s private office.

We outfitted all rooms and hallways with patient access with glass display cabinets holding cosmetic skin care products, sunglasses and informational pamphlets on the services we provide. Because we wanted an office environment that exuded low stress and comfort, we chose soft colors, sconce lighting with dimmers, and a Bose stereo system with speakers in every room.

The office is in a medical plaza with easy access, ample parking and a stall for the disabled 15 feet from the front door. Although most of our physicians travel between offices in five Central Valley cities, we chose to consolidate all oculoplastic patients to our new office, knowing they would be willing to travel outside their own cities for specialty care.

Figure 1, below, and Figure 2, left. The waiting and aesthetician/skin product rooms are welcoming and well-appointed.

Stepping Up With Online Marketing

Although historically we have been fortunate enough to stay busy in our 50-year-old practice without relying too heavily on advertising, Web site traffic and social media, our new oculofacial plastics and skin care office has essentially forced us to become more progressive in these areas.

We quickly learned that to grow the cosmetic part of the practice and compete with the plastic surgeons and dermatologists, we needed to increase our Internet presence and sophistication. This philosophy might be a piece of cake for young ophthalmologists just finishing their residencies, but for anterior segment surgeons whose familiarity with Facebook is limited to what they saw in the movie “The Social Network,” it’s a daunting task.

Despite our initial reservations in embracing the Internet, improving our Web site and Web presence has not only helped grow our cosmetic practice, but also contributed to greater patient flow and efficiency through our other offices. Patients can now print forms from our Web site that they can fill out and bring to the office when they come for their appointment. They can also use our Web site to educate themselves on premium IOLs and femtosecond cataract surgery.

Figure 3. Our minor procedure/skin laser room.

We now track Web sites that reference our practice name yet have no detailed information about our practice, and then claim those pages so that we can add photos and specific details about each of our practice locations. This also allows patients to write reviews on our practice and doctors, but more importantly gives us a presence on search engines when patients are looking for a local doctor.

More specific to the cosmetic side, we have updated our information with the various vendors from whom we purchase our cosmetic products and injectables, so that we are now featured on the vendor-specific search engines.

Social Media and ‘Beauty Bucks’

Social networking has allowed us to better market all the new technology available at our practice. For example, the day our femtosecond laser arrived at the ASC, we posted photos on Facebook announcing the availability of bladeless cataract surgery. Finally, we are creating an e-mail list of all our patients so that we can send them e-blasts of specials in our oculofacial plastic office and opticals.

Another unforeseen benefit of our oculofacial plastic office has been the ability to offer cosmetic services at a reduced cost and through a bonus program to our employees and their families. I’ve been injecting cosmetic Botox for 20 years to a handful of friends, relatives and patients, but never once did I think to offer it to my own employees (nor did they ask for it).

With more than 100 employees, mostly women, we decided to add “beauty bucks” to our benefits package. Employees now get an additional credit each year at our cosmetic office to be used for Botox, Restylane, facials, laser hair removal or any number of other products and procedures. Once they’ve used their “bucks,” they can purchase additional services and skin care products at a reduced cost. Not only do our employees fully use these benefits, but they have become our best ambassadors in the community (other than our doctors’ spouses, of course).

The Business Side

The biggest hurdle in creating an oculofacial plastic practice in a separate office is the obvious loss of economies of scale. The practice now needs another office supervisor, surgery scheduler, receptionist and technician, along with plasma screen monitors, EMR computers, automated perimeter and other necessary diagnostic equipment. As we all know, providing excellent care to our patients in comfortable surroundings with the best technology is only half the effort in building a busy, reputable practice. At the end of the day, all is for naught if the numbers don’t end up in the black.

This of course was the calculated risk we were willing to take when we started this whole endeavor. We were happy to find the Oculofacial Plastic Center profitable in its first six months. We also realized the obvious benefits associated with owning a freestanding ASC in the adjacent building — namely, patient convenience, excellent and efficient surgical care, and more cases at the ASC.

Maximizing Staff and Space

To maximize profitability, a practice must use the office space and staff efficiently. However, these efficiencies can be difficult to achieve in an office dedicated to a single subspecialty because that particular physician will be in surgery at least two half days a week, leaving the office and its staff without patients otherwise. We have tried to minimize this downtime by using the office for other services during the days our oculoplastic surgeon is in surgery or on vacation.

We now perform all intravitreal injections in the procedure room of this office during the two half days our surgeon is at the ASC and hospital. We also use the office space to see general ophthalmology patients, emergency add-ons and post-ops during vacation weeks. When we are unable to fill the downtime with patients for another doctor, we close the office and move some of the staff to cover in other offices as needed.

Although keeping all lanes occupied with ophthalmologists and optometrists all the time in a multioffice practice can be difficult, more times than not space seems to be at a premium. Using the oculoplastic suite to see general ophthalmology patients has come in handy.

Medical Still Rules

It may be too early to jump to conclusions, but I believe the “cosmetic” part of the practice (Botox, facials, fillers, skin lasers and skin care products), which certainly requires a lot of energy, marketing and day-to-day attention, provides much less of the profit than the myriad of functional eyelid, lacrimal and orbital problems that we treat both medically and surgically. A reasonable analogy is LASIK surgery in a busy general practice: The increased advertising, marketing and hype required to attract LASIK candidates leads the public to believe that most of an ophthalmologist’s income is derived from patients wanting LASIK surgery, when in fact most general ophthalmologists earn far more treating patients with cataracts, macular degeneration and glaucoma.

I bring this up not to discourage marketing Botox and skin care, but to emphasize the importance of caring for patients with functional eyelid, lacrimal and orbital problems — both to the practice’s financial stability and ophthalmologist’s sanity. Certainly, the early emphasis of our Oculofacial Plastics Center has been to encourage referrals from general ophthalmologists, optometrists and primary care doctors of their patients needing medical and surgical care of functional problems.

Although designing, building and equipping our oculofacial plastic suite was both time-consuming and expensive, we have been very happy with the results. Our new clinic allows us to see patients who desire cosmetic treatments and those with functional eyelid problems in an atmosphere that caters to their specific needs and concerns. It has also helped us grow both our tertiary and primary eye-care patient base. Despite the public’s perception of a spa filled with Botox, fillers and skin care products, the bread and butter of this office will always be patients with functional eyelid, lacrimal and orbital problems.

However, offering a variety of cosmetic services has forced us to upgrade our Web site and learn more about social networking, which I believe in the long run will grow the cosmetic side of the practice. In the meantime, our staff, their families and friends and, yes, even our doctors, will continue to enjoy the occasional visit to the clinic for a facial or other treatments or products. OM

John H. Zeiter, MD, is the managing partner of Zeiter Eye Medical Group, a multispecialty ophthalmology practice in California’s Central Valley, where he specializes in anterior segment surgery and practice management. Dr. Zeiter is associate clinical professor of ophthalmology at University of California, Davis.