Adding aesthetics to your business has been a hot topic recently, with many physicians wondering if they should add it to their repertoire of offerings. Although aesthetics can be very appealing, it is not always easy. Ultimately, its worth depends on your motivation and goals in the medical field, how it fits within your individual practice and the type of patients you care for. So, before adding aesthetics to your practice, it is essential to consider if it aligns with your professional journey.

My journey in aesthetics began unexpectedly around 2006 when a local hospital system opened a medical spa. Initially, they sought female surgeons to develop their women-only medical spa, providing training in injectables (neurotoxins and facial fillers) and lasers for skin discoloration, hair removal and skin telangiectasias. Over time, although the other female surgeons moved on, I realized I had found my niche in aesthetics and aimed to gradually integrate it into my own practice.

In this article, I will explain how I did that and what you will need to know if you are considering incorporating aesthetics into your practice.

TRAINING IN AESTHETICS

Aesthetic education doesn’t happen overnight, yet there are easy places to start. For a surgical-minded provider, the technical side of your skillset will likely come easily, with those who are good with their hands transitioning quickly. There are nuances, however, to having that “aesthetic eye,” or the artistic and creative part of assessing someone’s features. I now look at every client as if they are a work of art then develop an action plan to create the vision their individual structure needs. I never knew I had creativity within me until I entered aesthetics. Having that “aesthetic eye” is uncertain until you try.

For an MD, there are no specific certifications you need to obtain. However, training is essential so you can provide safe and effective treatment. Each company you partner with will have its specific training programs and clinical guidance processes to ensure this happens. These companies will either come into your place of business or have you travel to another site in order to be properly trained per their specifications.

You will be trained in both the science behind the products and in actively treating clients in person during your training. The companies that you ultimately choose to work with should support every effort for best outcomes and results. Ultimately, it is your job to ensure your training is adequate for providing the products and lasers you are using so you are obtaining safe and predictable results. Personally, I have invested a lot of time over the years attending many multi-disciplinary aesthetics, surgery and laser meetings, as well as weekend courses, and continue to do extensive reading and online education.

START WITH INJECTABLES

Injectables are the easiest place to start your entry into aesthetics, allowing you to get your feet wet while seeing if you really enjoy the aesthetic world. This point of entry also helps minimize any downside financial exposure. You can also do most of the services from your current exam lanes with minimal need for new furniture or a change in your current office setup.

Choosing a injectable company to use is a personal preference. I would advise starting with one single company and one that has neurotoxin and multiple fillers in their product line — do not feel that you need to offer every injectable under the sun. We currently have three different companies we use (Galderma, Revance and AbbVie). Get to know that one line, and how to use it well. Then, as your patient base grows, look to add another.

Products are expensive and have expiration dates. So, keep your inventory small to begin with, then adjust as your volume of clients increases. It is always a disappointment when good product goes to waste due to it expiring. This lesson was the most difficult to learn when I began. Although we still watch this closely, it is rarely an issue anymore.

INVESTING IN LASERS

If you are considering lasers, begin by looking only at companies that have technology you are truly interested in and that have a product that will meet your needs — but figure out what your needs are first! For example, the first laser I bought was to help optimize options for my surgical eyelid patients. I wanted to be able to improve the lower lid skin in a non-surgical approach. This same machine also had a component that helped me minimize brown and red discoloration, could be used for minimal downtime skin ablation, and it could also be used in my dry eye program. I found it helpful when starting out to be able to justify the multidisciplinary action of one laser device for both sides of my practice.

Beyond that, vet the company and consider the following questions:

• Are they kind?
• Are they responsive?
• Are they there to educate you, truly caring what is best for you and your practice vs just making the sale?
• Are there consumable costs for each treatment?
• Is it painful?
• Does it actually work?
• Are the before and after photos advertised realistic?
• Are there peer-reviewed scientific papers that have been done on the technology to prove its efficacy?

To help, many companies will bring the laser to you and allow you to trial it as you are investigating. If you have not tried it yourself and on others, I would be hesitant to buy it. Lasers are a large acquisition and change quickly. Take your time as you investigate what will meet your needs best.

THE BUSINESS SIDE OF AESTHETICS

On the business end, my advice is to keep things simple at first. Time is precious, cost of goods are high, and you also have your surgical eye side to grow and manage. I provided only injectables for about the first 5 years and did so out of my existing eye exam lanes. I knew that I ultimately wanted a true medical spa, and these initial years gave me time to investigate further opportunities and to set up the medical spa business while I gained confidence in my skills. It also allowed me time to understand the “how and what” I wanted to offer future clients.

In 2013, I opened the medical spa within the walls of the current office. This is also when I added in my first laser to create a true skin and laser center, with its own dedicated space, name and staff. It operated like its own business entity and continues to do so.

Items to consider for how you want to manage the business side are numerous, but I will list my top recommendations here.

Silo costs

Are you going to incorporate your aesthetic overhead costs into your surgical eye practice, or are you going to silo them into their own cost center? I recommend the latter and from the beginning. I didn’t do this in the beginning, but once I opened the skin and laser center, this became necessary and valuable. How do you otherwise know if you are making or losing money, what is working or not, and how to set future goals? If costs are hidden in your surgical medical practice, the picture of success or failure will become diluted. Collecting data and following trends for each segment of your practice is the only way to determine the value for your time and where you want to focus more or less effort.

Schedules

Starting out, it is likely that you are going to be the main and only provider when adding aesthetics. Therefore, consider the following questions:

• How will you structure and value your time?
• Do you only do aesthetics on days you are currently not scheduled for your surgical practice?
• Do you mix them in with your clinic patients?

I caution mixing aesthetic clients with your medical patients. We never know quite how medical appointments will go or the time they will entail. This leads to the dreaded “wait time” and getting behind in the schedule. Although your clinic patients may be somewhat forgiving to this, your aesthetic clientele will not be. Appointments need to start and end on time. When I was the only provider for both my eye side and my skin and laser center, it meant that my aesthetic clients always took priority. It was a catch 22, and it “worked” but at the cost of the best experience for my patients, my clients and myself (in my sanity).

Remember, aesthetic clients are choosing to come see you for something they want and not something they need. They can and will choose somewhere else if the above is not managed.

Staffing

When beginning, I think it makes sense to use your current staff, which likely includes your eye technicians. Yet they may or may not be your best source. Not everyone is aesthetically minded, so choose wisely. Elective patients need cheerleaders and confidence builders, and your staff need to be able to perform this role with you. You may very well have “that person” on your team already.

Depending upon the above, do you need a separate dedicated team member for this venture? Is this full time or part time? Is this an aesthetician, who already has that “aesthetic eye,” an RN or an advanced provider (PA or NP)? There is no wrong answer, just things to think about and the “how” you will take care of your aesthetic clients that may differ from your medical eye side. After 10 years in my dedicated skin and laser center, there have been many iterations of schedules and types of staff. Find what works for you and your team and your “why” behind incorporating aesthetics.

KNOW YOUR STATE LAWS

If you are thinking of adding a service provider besides yourself to your practice, it is imperative to know your state laws. These vary greatly from state to state and will dictate what services can be provided by whom such as operating lasers and injecting. In my state, lasers can only be operated by mid-level providers or above. RNs or above can inject. In other states, an aesthetician or RN can obtain laser certification and perform many higher end services.

This will alter your overhead and profitability, but more importantly, you need to ensure you are performing services legally within your walls. This information can often be found on your state’s website, and if there are any questions, I recommend seeking legal counsel.

BLENDING WITH OCULOPLASTICS

If you are already offering surgical oculoplastics, adding aesthetics may be an easier extension of surgery and a very natural fit — for you, your current staff and patient population. Yet, I also believe that having a growing elective cataract and refractive practice allows for a natural blending into aesthetics because the psychology of the patient is very similar. This patient type often desires to optimize their best self, in both visual freedom and how they see themselves in the mirror.

I am a cornea and refractive fellow, yet I also had great general oculoplastics training and enjoyed it. My pathway back into plastics began early in my surgical career when I was asked if I wanted to start doing eyelids in our community. I said, “why not” and sharpened up my skills by revisiting many of my residency attendings and spending time with them in the OR, relearning the basics of blepharoplasties and ptosis repair. It was around this same time that I was asked to join the new women’s medical spa … and the rest has snow-balled from there.

I feel a great comfort level in aesthetics having had this extra background in plastics, truly allowing me to blend my surgical eye world with my aesthetic world. We now are able to offer many laser resurfacing procedures as elective additions for any surgical eyelid patient, as well as discuss total facial rejuvenation in the clinic exam lane with those patients interested in more than just functional or elective blepharoplasties. It is not uncommon to discuss laser resurfacing to brighten and tighten the skin, as well as injectables for brow ptosis, glabellar furrows and crows feet. We also often discuss facial fillers for mid-face volume loss along with support of the lid-cheek junction, both of which can accentuate lower lid tear trough deformities and orbital fat prolapse.

MARKETING AESTHETICS

Everyone thinks aesthetics will be “so easy.” While it is fun (or can be!), it is a lot of work. The business is fickle, and the clients can be fickle. Also, there are many options for them. Because of this, you must market differently. What works on one side will not necessarily work on the other. Your population is different. For my practice, social media is a big marketing tool on the aesthetic side and small on the eye side, whereas more traditional digital marketing is stronger on the eye side. I do not feel you need to spend money on marketing your aesthetic side. Utilize your in-office options such as scrolling video monitors. Use social media. Make sure your website is up to date with your new offerings. Get your staff excited about the offerings and let them share that excitement with your patients. Simple things can go a long way as you are beginning.

CONCLUSION

While I initially fell into aesthetics, I have stayed because it is fun … and highly addicting. The technologies that have been created, and the science behind them are truly fascinating and ever-changing. I have personally trained on every single piece of equipment we own, and I know how to operate the machine and perform treatments using safe, effective settings. There is an art to performing lasers. And you need to use them frequently enough to develop your skillset. Only by doing can you understand, guide and teach those who have a hand in your business.

My love for aesthetics also comes from seeing healthy skin. The goal is never to erase every line, wrinkle, pore or area of skin laxity, but to work on health. I coach my clients that if we strive for health we will win every time. Like great works of art, our skin/faces/bodies sometimes need to be created (if we never had something), restored (to get things back we have lost) and then maintained to keep what is good.

If you are not all in for this program, and you do not believe in these things for yourself … then why are you going make this part of your practice? I believe in this for myself and for my patients. I practice what I preach. I obtain items that I myself feel are valuable for my “why.” And then I create a program around that technology or offering for my clients.

If are you considering adding aesthetics, do it because you love it. Beware, however: Although technically easy on one hand, it becomes complex quickly on another when you consider you will work just as hard, although in a different way, to gross the same and likely bring home less.

So why would anyone want to do that? If you follow your passion, like I did, the rest will take care of itself. OM

Alison R. Tendler, MD , is a board-certified ophthalmologist, is the visionary behind ART Vision and ARTisan Skin and Laser Center in Sioux Falls, S.D. With a passion for education and a focus on patient experience, she is expertly skilled in the areas of lens-based refractive surgery and oculoplastics, working to optimize her patients’ vision while giving them a high-end, personalized experience. She also aims to help patients create the best version of themselves through her medical aesthetic clinic. Dr. Tendler focuses on finding the beauty in every day and practices with one goal in mind: to help patients see the world better and see themselves better. Dr. Tendler reports no relevant disclosures.