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Be prepared - things can and do go wrong in cosmetic dermatology


Common myths of cosmetic dermatology include the assumptions that one will never make mistakes, that malpractice insurance automatically covers cosmetic tools and treatments, and that the Internet is an easy place to do business, an expert says.

Key Points

In cosmetic dermatology, as in life, "Everything that can go wrong has potential to actually go wrong.

"So one must train and perform so as to get the best possible outcomes, but be aware that suboptimal results happen," Noah Scheinfeld, M.D., J.D., assistant clinical professor of dermatology at Columbia University, tells Dermatology Times.

Web sales and content are trouble-free

In one case, Dr. Scheinfeld says, a physician hired a contractor to build a Web site mockup. Unfortunately, the contractor used some copyrighted images, which resulted in a demand for payment from the images' owner.

In the Google age, Dr. Scheinfeld cautions, "It's easy to look for specific pictures that are tagged with certain data. One must be extremely careful" how one represents one's business online. "Best to use people who are reputable" in hiring out such functions, he says.

Dispensing products is a cinch

In this area, Dr. Scheinfeld says one must beware of dispensing unapproved products, consider tax laws and know what warranties apply.

My PAs don't need supervision

Even the best PA knows only a part of what a good dermatology resident would know, Dr. Scheinfeld says.

"For example," Dr. Scheinfeld says, "when one does a biopsy looking for pathology in the fat, one must do a 6 mm punch biopsy or an incisional biopsy, because a smaller biopsy punch doesn't get down to the bottom" of the area being checked. When a dermatology resident makes such an error, an instructor quickly corrects it, Dr. Scheinfeld says.

However, he says, "Well-trained PAs don't know that because they might never have encountered a case of erythema nodosum where this issue came up. And they're not attuned enough to know what they don't know," which could pose problems when it comes to serious illnesses or cases with a potential for complications.

All patients will love their doctor

"Sometimes, patients will be very difficult. One must be aware of and prepared for that," Dr. Scheinfeld says.

Key tools in this area include proper informed-consent procedures and "before" and "after" clinical photos.

"Letting people know about the risks is crucial, particularly with cosmetic procedures, because those patients sometimes have psychopathology," Dr. Scheinfeld cautions.

Malpractice insurance covers all cosmetic tools and toys

"One can buy Botox (botulinum toxin A, Allergan) for $100 a bottle in Brazil - but malpractice insurance will not cover that."

Similarly, Dr. Scheinfeld says, "If one is doing something that is off-label, not the standard of care or in any way radical, it never hurts to call up one's carrier and ask if you're covered" should something go awry.

Different states frequently handle such matters differently, Dr. Scheinfeld adds. For example, he says the state of New York has two classes of insurance - one for medical dermatology and another, more expensive, class for surgical dermatology. Never assume surgical or cosmetic procedures fall under the medical umbrella, Dr. Scheinfeld says.

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