Aesthetic procedures are a natural progression for ophthalmologists to bring into their ambulatory surgery center (ASC), especially if a practice already performs some oculoplastic procedures or has an established self-pay revenue model for offerings such as refractive surgery or selling optical or other retail products, says Lisa K. Feulner, MD, PhD, founder of Advanced Eye Care and Aesthetics in Bel Air, Maryland.
Nathan W. Blessing, MD, an assistant professor of clinical ophthalmology and an ophthalmic plastic and reconstructive surgery specialist at Bascom Palmer Eye Institute in Palm Beach Gardens, Florida, agrees. He says that some aesthetic oculoplastic procedures are natural complements to functional surgery that patients are already having performed. “Providing additional aesthetic services can not only be profitable, but it can also give patients the best possible comprehensive outcomes,” says Dr. Blessing.
Getting Started
Before jumping into a new business venture, Dr. Feulner recommends asking and answering six questions: Why? When? What? Who? Where? How? “This is important to do if you’re considering adding a product or service line in an area you don’t possess expertise in, such as aesthetic procedures,” she says.
Ophthalmologists interested in adopting aesthetic procedures into their ASCs can become educated by attending lectures and instructive meetings, reading articles, and learning from trusted colleagues and mentors to gain hands-on experience, Dr. Feulner says.
Learning and understanding all state-specific rules and regulations regarding aesthetic procedures is essential. The certification required to provide aesthetic procedures is state dependent; these requirements can impact the types of services an ophthalmic practice can offer and who can perform them. Ophthalmologists should also ask whether their malpractice insurance company requires certain approval measures, procedures, or protocols to be set up in their office or ASC in order to stay protected from a malpractice perspective, Dr. Feulner says.
Dr. Blessing recommends thoroughly investigating which procedures would be best to offer initially, and what additional supplies, instrumentation, or equipment would be needed. Providers will need to be comfortable with procedures and be willing to teach the anesthesia and operating room staff the nuances of performing them.
Dr. Feulner advises moving slowly, by identifying and developing one target market before introducing the next one. “Staff often need time to learn and incorporate new processes,” she says. “They must be knowledgeable and comfortable each step of the way. Schedules may change, ASC space utilization may have to adapt, and providers may need to master new skills.”
Initial Offerings
Jemshed Khan, MD, an oculoplastic surgeon at Khan Eyelid and Facial Plastic Surgery, LLC, in Overland Park, Kansas, recommends starting out by offering several procedures, such as blepharoplasty, ptosis repair, and ectropion and entropion. These soft tissue procedures don’t take much time to perform, don’t require a lot of sedation, and don’t carry a lot of risk.
Incorporating botulinum toxin (Botox; Allergan) and a skincare line is the easiest entry point for ophthalmologists considering growing an aesthetics practice, Dr. Feulner says. Many have already been trained or currently use therapeutic Botox to treat blepharospasm, hemifacial spasm, migraine headaches, and TMJ.
Ophthalmologists are well trained in facial anatomy and can easily learn and obtain further education and certification in cosmetic uses for Botox, Dr. Feulner continues. A skin care line can complement the overall desire to create healthy, youthful-looking skin and requires minimal time and skill.
Dermal fillers are another viable option, which are more profitable but do require additional skill and training, Dr. Feulner says. Skin tightening and wrinkle reduction lasers, intense pulsed light (IPL) treatment, and full body fat contouring (CoolSculpting; Zeltiq Aesthetics) are time-consuming and require a larger investment. More invasive procedures such as subdermal fat and tissue coagulation come with a higher price tag, but are the most profitable.
Dr. Blessing says the most popular aesthetic procedure at his ASC is patients adding on a lower eyelid blepharoplasty if they’re already having a functional upper blepharoplasty. This is closely followed by adding a cosmetic upper blepharoplasty to a functional ptosis repair. The reasons are twofold: first, the patient is already in the operating room for surgery; and second, the cost of an add-on aesthetic procedure is cheaper than if they were just having the aesthetic procedure.
Current Demand
Social media has created a culture of increased awareness of one’s appearance at all times. “Aesthetic procedures are not only accepted, but augmented features are also admired and a status symbol,” Dr. Feulner says. “Having procedures to improve one’s appearance is no longer taboo and the conversation surrounding it is acceptable and normal.”
Dr. Khan has found that three populations are seeking aesthetic procedures. First, people at any age may decide to have a procedure to enhance their appearance. Then, there are patients age 40 and over who are experiencing changes due to aging and have the income and desire to transform their appearance. Finally, there are individuals who are enticed by web-based and internet-based marketing efforts who don’t have the contacts or social networking circles like the older groups who find surgeons through word of mouth.
When expanding your ASC’s aesthetic offerings, Dr. Feulner recommends identifying potential existing patients who might be interested in your services and focusing sales and marketing efforts on them. Getting involved with community events and non-profit fundraisers can increase awareness. These groups often have silent auctions, making it easy to offer an aesthetic procedure for free or at a discount without spending money on advertising, Dr. Feulner says. The products used in the fundraiser can often be obtained from a practice’s industry partner, further decreasing the cost to the practice while expanding community awareness and exposure.
Partnering with local health clubs and hair salons can also be a great resource for referrals for younger patients and patients with disposable income, Dr. Feulner says.
Web and social media–based marketing using Facebook, Twitter, or Instagram accounts is popular among younger physicians, says Dr. Khan, who recommends posting patient testimonials. Marketing can be aimed at all patients in a practice’s database.
With regards to oculoplastic surgery, Dr. Blessing often demonstrates to patients the additional improvements that aesthetic procedures might provide using tape, cotton-tipped applicators, before and after photos, and simple discussion.
Potential Costs
The cost of opening an aesthetic practice depends on a variety of factors, including whether you have existing employees whom you can train in the new offering or if you need to hire new ones, Dr. Feulner says.
The cost also depends on whether a practice will need to take out a loan to implement the new plan or buy an existing practice. Merging with or acquiring another business can double a practice’s size, increasing potential sales and revenue exponentially. Furthermore, a practice may need to buy additional equipment or redesign part of their space to create a spa-like feel, Dr. Feulner says.
Remodeling a practice may or may not be necessary, depending on an existing practice’s space, style, and targeted clientele.
As a result of HIPAA privacy rules, most ASCs already provide private spaces for patients, which is essential for those having aesthetic procedures. “If high-profile public individuals are part of your target demographic and you have a surgeon who is experienced in handling these types of individuals, then it may be worthwhile to invest in a private entrance,” Dr. Khan says.
In addition to privacy, patients who are having aesthetic procedures may also want anonymity and may expect a medical spa–like environment. “While surgery centers are clean and antiseptic looking, which can give patients confidence that their procedures are being done in a safe environment, the relaxing spa-like feeling can often be missing in this setting,” Dr. Feulner says.
Ideally, Dr. Feulner says an ASC-based aesthetic practice could either be attached or adjacent to the main office with its own entrance and waiting area. This exposes patients in the office setting to the aesthetic spa, making them aware that the practice offers these solutions. Patients can be easily referred back and forth between practices, and staffing and resources can be shared between an office, aesthetic and med spa, and the ASC.
Making Services Affordable
Aesthetic procedures are often considered elective surgery, and therefore aren’t covered by Medicare or many insurance plans. To make them affordable, practices can offer discounts, usually subsidized by industry partners, Dr. Feulner says. Offering an interest-free payment plan such as Care Credit is a necessity.
Dr. Blessing recommends offering discounted surgeon, ASC, and anesthesia fees to patients who are already having functional surgery. “The functional surgery will already help to reimburse an ASC for a lot of the time a patient is there,” he says. “Having a comprehensive pricing strategy allows ASCs to keep costs reasonable but profitable. Do some investigating up front to determine how much a block of additional time in the operating room costs an ASC in terms of overhead.”
Possible Pitfalls
While there are many benefits to adding aesthetic procedures to an ASC, there are also some potential downsides to be aware of. For example, practicing in the aesthetic space can put a practice at high risk if a surgery doesn’t go well. “Patients will be relatively unforgiving if their outcomes aren’t good,” says Dr. Khan. “You may have to deal with patient complaints on social media platforms. Be proactive to avoid patient complaints and determine how you’ll handle adverse publicity if it happens.”
If your location isn’t convenient to the population you’re marketing to, you’ll have subpar results. Likewise, if people in your demographic can’t afford aesthetic procedures or they aren’t a part of their cultural norm, then your surgical volume will be disappointing, Dr. Khan says.
Be prepared to handle competition from a variety of physicians, since aesthetic procedures are commonly performed by many types including general practitioners, dermatologists, plastic surgeons, OB/GYNs, and dentists, Dr. Feulner says.
Dr. Blessing cautions against pricing procedures too high, which will deter some patients. He also advises negotiating for new equipment or buying used equipment initially if you’re unsure whether your patient stream will support it. You can always upgrade later.
There’s a lot to consider when deciding whether to add aesthetic procedures to an ASC’s offerings. Doing your homework will help to determine if it’s right for you. ■
