Getting in on the aesthetics boom

Adding cosmetic procedures can be a low-maintenance boost to your practice.

By René Luthe, Senior Associate Editor

With US refractive surgery volumes still significantly below those of the boom years in the early 2000s, ophthalmologists are not pinning their hopes for prosperity on a near-term LASIK resurgence. However, other elective procedures, among them cosmetic and oculoplastic procedures, have shown them-selves to be almost impervious to problems such as weak job markets and volatile consumer confidence ratings.

The American Society of Plastic Surgeons reports that cosmetic procedures rose 5% from 2011 to 2012, to 14.6 million. Compare this to approximately 800,000 refractive procedures in 2011, according to AllAboutVision.com. Minimally invasive cosmetic procedures rose 6% from the previous year. And why not? As Michael Migliori, MD, president of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) points out, one of the most popular minimally invasive procedures, cosmetic injectables, offer the following advantages over LASIK: no, or very brief, recovery time; a significantly lower price tag; and less invasiveness.

“Botox you can do on your lunch hour,” says Dr. Migliori, who practices in Providence, R.I. From the physician’s perspective, cosmetic procedures share one attractive advantage with refractive surgery: No third-party payer to deal with. More and more physicians are offering these procedures. Not that adding aesthetics to a practice is easy. From deciding which procedures to offer to training to décor to marketing in an increasingly crowded field, the move requires careful planning.

LEARNING AESTHETICS

You’ll need some training

If you are simply offering Latisse (bimatoprost ophthalmic solution 0.03%, Allergan, Irvine, Calif.) for eyelash lengthening, you won’t need to do an enormous amount of research on the product, but expect to put in some time learning anatomy and techniques to master any other cosmetic procedure.

However, while dabbling in aesthetics won’t do if you want a thriving practice, training to inject dermal fillers or botulinum toxin, administer chemical peels or perform light and laser treatments is not that onerous, according to ophthalmologists who have incorporated these services. Becoming proficient requires reading, attending lectures, workshops and live demonstrations, and a lot of practice, says Wendy W Lee, MD, of Bascom Palmer Eye Institute, Miami. These are widely available.

“The filler manufacturers all have a promotional type of a program, but they only encompass applications that are on-label, or FDA-approved” says Steven Yoelin, MD, of Newport Beach, Calif. “It’s a little easier for a new injector” than it was when he began injecting Botox (onabotulinumtoxinA, Allergan) 13 years ago, when its use for glabellar lines was off-label. “Doctors today have the advantage of FDA approval for injectables and the development of pharmaceutical companies’ promotional programs.” ASOPRS also offers training sessions (box).

Find a preceptor

Robert A. Goldberg, MD, of Jules Stein Eye Institute in Los Angeles, recommends observing experienced practitioners. In most cities, he says, you can find physicians who will allow you to watch them perform the procedures, either for a fee or simply for the love of teaching. “There’s nothing more valuable than having a relationship with someone who is experienced on an ongoing basis because the better you get, the more you start to understand what you are not good at,” he says. “It’s always nice to have a mentor, or a preceptor whom you can call with a question or a complication.” Dr. Goldberg believes a dedicated clinician can learn basic plastics work in two to three months.

Although, Dr. Migliori notes, more advanced procedures will require a longer training period than, say, learning to inject Botox into the frown lines, or the “11’s” of the face. “That’s straightforward,” he explains. “The more advanced techniques involving the forehead, or trying to get the brows elevated or around the mouth, require a lot more training and understanding and supervision to become adept.”

Judicious patient selection

But mastering the technical aspect of performing a procedure is only part of the learning process with aesthetic procedures, Dr. Migliori cautions. Judicious patient selection is just as important. “Deciding who needs what is a much longer process,” he says. Understanding who is or is not a good candidate for various procedures or products requires time and thought. “That’s not something you just want to stumble into,” Dr. Migliori says.

After all, as Dr. Goldberg points out, these patients walk in healthy and bring high expectations. “There’s zero room for complications,” he warns.

So it’s crucial for the clinician to listen to patients to learn about their aesthetic concerns and expectations, Dr. Lee says. “I let them speak first, then I inform them about the modalities that I can offer them to address these concerns,” she says.

STAFFING NEEDS

Find a ‘wing person’

The good news is, adding aesthetics to the practice does not mean that you will need to add staff, especially for minimally invasive procedures. Dr. Lee reports that while cosmetic procedures comprise about one-third of her practice, she has trained a nurse to do the chemical peels. As for the injectables, laser and pulsed-light treatments, “I do them myself"

Cosmetic injectables offer the following advantages over LASIK: no, or very brief, recovery time; a significantly lower price tag; and less invasiveness.”

An office with out-of-date magazines and a brusque staff will not impress cosmetics patients.”

Dr. Yoelin agrees that aesthetics can be “a low overhead environment.” Because he offers only injectables, he says he only needs one staff member to schedule appointments, help check patients in and out, and – this part is critical – answer patients’ basic questions about the procedures and products he offers. “You need a ‘wing-person,” Dr. Yoelin explains. “That person has to be well-educated so she can walk patients through a procedure.”

For example, if a patient asks about dermal fillers, this employee would explain the various products the practice offers, the differences between them and show before-and-after photos. It’s helpful too, Dr. Yoelin says, if your “wing-person” uses the products herself so she can vouch for their efficacy – and your technique. This assistant should not engage in high-pressure sales pitches, but instead seek to educate current and potential patients.

A different mentality

While you may not need additional staff to offer aesthetics in the practice, the existing staff will need to embrace a concierge level of customer service for the venture to succeed. With so much competition in the cosmetics market, staff must focus on making the experience as pleasant as possible.

“I noticed more and more in my practice that it must be a good experience for patients,” Dr. Goldberg says. “Patients come in not only for the actual, technical component of the work, but also for the experience of staff who are fun to talk to, and a surgeon who is willing to listen to what their aesthetic goals and ambitions are in terms of the procedures. I think patients immediately sense whether the staff is interested in those things.”

OFFICE DéCOR

Getting the right ‘look’

Ambiance and décor play a role here as well. The practice should look like an aesthetic practice, Dr. Goldberg says. An office with out-of-date magazines and a brusque staff will not impress cosmetics patients. “A bright, cheerful, professional-looking office that has some sense of aesthetics, even in the way the office is laid out,” will do more to persuade patients that yours is a practice that would deliver the desired results, Dr. Goldberg says.

An office that looks “clinical” can also be a disadvantage with this patient group. Dr. Yoelin explains that in such an atmosphere, patients may not even think the practice offers cosmetic procedures and products. Sales representatives in the industry can help with ideas to practices new to aesthetics, he adds, because they go into such practices every day and are familiar with successful strategies. And although brochures alone are not sufficient marketing tools, a dedicated area in the waiting room for promotional materials to inform patients of their practice as a whole, and the various services they offer, is a must.

GETTING THE WORD OUT

Seize the good fortune

Many medical specialties have difficulty getting patients to come through their doors, Dr. Goldberg notes, but ophthalmology has the good fortune of having a sizable patient flow. Moreover, he says, “These are often patients with whom you have a long-term relationship.” The ophthalmologist’s situation is perfect for internal marketing – in the form of signage, e-mail newsletters, Web sites and social media – to inform patients of new services.

Because your patients already trust you, they are more likely to exhibit patience as you perfect your technique.”

Dr. Yoelin agrees and points out that internal marketing is far less expensive than hiring a consultant. And because this population already trusts you, they are more likely to exhibit patience as you perfect your aesthetics techniques.

“It’s always going to be a little bit rocky when you are starting out,” Dr. Goldberg explains. “You’re not going to be as good your first year as your fifth year.” Having patients who know and trust you and are willing to show you understanding is going to be more valuable than new patients who come in response to a newspaper ad. “Those patients come in with high expectations and a certain amount of skepticism about the practice because they don’t know you,” he says.

Appealing to a new age demographic

On the other hand, internal marketing is likely to have its limits for ophthalmologists. While they enjoy higher patient volume than many other specialties, the age range of ophthalmology’s patient base is older than that of the typical plastic surgery practice. “That’s the hard part,” Dr. Yoelin says, citing the 70-somethings that comprise his ophthalmology patient base vs. the 40-somethings who come to him for dermal filler injections. Still, he maintains, internal marketing is helpful. Patients in their 60s and 70s, he points out, probably have younger friends and relatives. Besides, those in their senior years now often want to look good, too.

Practices offering LASIK, of course, have access to a younger demographic. Those that don’t, however, can follow Dr. Yoelin’s example and try a more unorthodox approach: He reached out to hair salons and aestheticians and told them about the new services he was offering. “With these aestheticians, I developed a younger, more aesthetically-oriented patient base,” he says.

Dr. Lee advocates reaching out to the community as well. “Marketing is key, because there is a lot of competition for cosmetics services,” she says. “I recommend that a physician trying to grow an aesthetic practice get exposure in the community by giving small-group talks to women’s groups such as the Junior League, or donating at silent auctions, for example.”

Return business

Once you develop a patient base – and a reputation for excellent service – many cosmetics patients will return at regular intervals. For injectables, Dr. Yoelin says patients typically return every four to six months. “It’s not like LASIK or cataract surgery, where once the patients are fixed, they’re done,” he explains. “These people are never done.” Thirteen years after he began his cosmetics practice, Dr. Yoelin reports that he does not have to market anymore. “The practice is self-sustaining.” OM