As cataract reimbursements continue to decline, more and more ophthalmic surgeons have been expanding into other specialties. And, for many, oculoplastics has been a natural transition.

A growing segment of the population is interested in these procedures—in particular, Baby Boomers. With patients having just spent so much of the last year and a half looking at themselves in high definition for video conferencing, the demand appears to be exploding. But do these procedures have a place in the ASC, or are they best suited to the office? And for doctors adding these services, which make the most sense?

Lisa K. Feulner, MD, PhD, founder of Advanced Eye Care & Aesthetics in Bel Air, MD, feels anything requiring sedation is a better fit in the ASC. This includes blepharoplasty or brow lifts. But for injectables, fillers, and other simple treatments, the office works just fine.

“Personally, for any relatively extensive surgery, I’m much more comfortable performing it in the OR with an anesthesiologist,” Dr. Feulner says. “But I have seen a movement of some procedures out of the ASC and into the office—including even cataract surgery.”

Dr. Feulner says that for doctors who own an ASC, it makes a lot of sense for them to optimize it for plastics. But if doctors don’t own one, there’s a financial aspect to consider. Bringing procedures into the office can be more profitable.

Melissa Toyos, MD, partner and research director of Toyos Clinic in Nashville, TN, says she has seen both sides of the spectrum. When she previously worked in a practice that owned its own ASC, it made a lot of sense for her to perform oculoplastics there.

“I would take the Thursday and Friday slots, which was generally time that the cataract surgeons did not prefer—but was perfect for plastics,” she recalls. “It would give patients the weekend for downtime, and then I would see them back in a week.”

Dr. Toyos says that one of the aspects of oculoplastics that makes them a nice fit in the ASC is that there is not as much time needed for room turnover as there is for other procedures. Plus, the instruments are less expensive and complicated compared with cataract surgery, which can lower the barrier to entry.

But both Dr. Toyos and Dr. Feulner have had success in performing nonsurgical procedures, such as Botox (Allergan) and laser treatments, and offering Latisse (Allergan), an FDA-approved treatment to grow eyelashes, in the office. The key, they both say, is that these types of procedures should be separated from the primary ophthalmology practice.

“When patients are paying out of pocket for these procedures, there’s a certain level of expectation in terms of having it feel spa-like,” notes Dr. Toyos. “They want snacks and bottled water and a cozy waiting room—and they absolutely expect privacy. We have a separate entrance and parking lot with tall hedges that give our patients privacy when they come in for these procedures.”

Dr. Feulner agrees that privacy is absolutely imperative, though there was a time when these procedures carried some sense of taboo with them. Although that is mostly gone, she says patients still want privacy.

“We are also performing Cool-Sculpting treatments [for fat reduction], and patients have to remove all of their clothing,” Dr. Feulner adds. “That means they also need access to a private changing room and bathroom. They don’t want to be mixed in with the general ophthalmology patients. We keep it completely separate.”

Dr. Toyos says that she has had a tremendous amount of interest in fractional C0₂ laser treatments, and particularly likes the MiXto CO₂ fractional laser (Lasering USA), which uses heat and energy to rejuvenate the skin.

“A procedure like this is a nice, noninvasive alternative to something like a blepharoplasty that’s going to have more downtime,” she adds. “It does a very good job tightening the skin, making it thicker and smoother. The skin actually looks and acts like younger skin.”

Financing Plastic Procedures

Because these types of procedures generally require that patients pay out of pocket, they may be interested in financing options.

Dr. Feulner says that although her practice doesn’t offer financing through the office, they have brochures on hand for CareCredit. Dr. Toyos also shares information on CareCredit, as well as Sunbit, with patients looking for buy now, pay later solutions.

“A lot of companies offer rewards programs in which they supply cash credits for future procedures,” notes Dr. Feulner. “Allergan Aesthetics has offered patients a loyalty program in which they can earn credit on their next treatment. That works out well on our end because the clients like it, but we get paid back for any discounts on future work.”

In addition, Dr. Toyos says that her practice created an internal rewards program to encourage clients to try new and different procedures they offer.

Making the Transition

In terms of taking the leap into this arena, both doctors say it’s not a far jump. Dr. Toyos says that injectables are a great place to start.

“Injectables are an easy transition for eye surgeons, because they’re already skilled at working with them for clinical reasons,” Dr. Toyos says. “I work with Botox and Juvéderm (Allergan), and also Kybella (Allergan).”

Dr. Feulner agrees: “Botox in the hands of an ophthalmologist is a natural fit, because we’ve already used it therapeutically.”

She adds that carrying a skincare line is also a really great transition product.

“From there, you can grow,” says Dr. Feulner. “There is such a demand for fillers, lasers, and even full-body contouring right now—but start small and get comfortable with each product or line that you add.”

Dr. Feulner says that she grew her own aesthetic division by adding something new every 6 months. She says that was the perfect timing.

“It helps to ensure that you always have something new and fresh, but that you are not overwhelming your staff,” she says. “I never added more than one new thing at a time.”

Dr. Toyos says she grew her aesthetics division organically—by improving her existing patients’ eyesight. Upon obtaining better vision, their demand for aesthetic improvements emerged.

“So often, after these patients had cataract surgery, they were suddenly noticing that their lids were droopy,” Dr. Toyos says. “I was explaining again and again to patients that it was like that before—they just couldn’t see it. I found myself in this pattern of performing blepharoplasty 6 weeks after cataract surgery, over and over. And that’s how I started building my aesthetics practice.”

Reaching Patients

When it comes to marketing, before-and-after pictures can be incredibly powerful, says Dr. Feulner. She has also had great success with hosting events, such as a “Girls Night Out.” She adds that anytime a practice is trying to build something new, it makes sense to start with the base of existing patients.”

“We might host a night where you could win a door prize and earn an extra entry ticket for bringing a friend,” Dr. Feulner says. “Oftentimes, your vendor partners will provide free products to raffle off, and they’re willing to perform demos. You might even have someone volunteer to get a free treatment, such as Botox, to show everyone what it’s like. When you make it fun, it’s a great way to introduce it to the community and generate interest.” ■