Geriatric aesthetics: Medicare, elderly patients can lift cosmetic practice

September 1, 2008

The full-body skin exam provides an opportunity for dermatologists to broach cosmetic topics of interest to aging baby boomers, an expert says.

Key Points

Colorado Springs, Colo. - Serving the cosmetic needs of one's geriatric patients, including those in the Medicare population, can have a positive impact on one's bottom line, not to mention one's quality of life and these patients' health, a California dermatologist says.

By 2050, one in five Americans will be 65 or older, says Wendy E. Roberts, M.D., a dermatologist in private practice in Rancho Mirage, Calif.

Boomers who appreciate the value of cosmetic dermatologic treatments also may want their spouses, siblings and even parents to look younger, she says.

Dr. Roberts says in her practice, the idea to serve elderly patients' cosmetic needs grew out of a dilemma common to many dermatologists' practices.

About five years ago, she says, she was seeing 35 patients daily and noticing that many of them had cosmetic issues they weren't aware of that required more time and attention than their appointments allowed.

Combining exams

To address this dilemma, Dr. Roberts began offering full-body skin examinations (FBSEs) as a tool to practice top-quality medicine and expand her cosmetic practice. The FBSE begins with a review of the patient's medical history, then follows with a head-to-toe assessment of all the patient's skincare issues.

"I actually combine the medical and cosmetic issues in the same exam," she says.

For example, a patient may have a basal cell carcinoma on the cheek and rhytids on the chest. Dr. Roberts says the FBSE provides an opportunity to talk about both at once rather than schedule separate appointments for each issue.

"I'll discuss the treatment for each problem, then develop a summary worksheet that the patient takes home or to the cosmetic coordinator," Dr. Roberts says. The summary worksheet encompasses three areas - medical, cosmetic and skincare concerns - on one page.

Many dermatologic disorders that commonly afflict the elderly benefit from cosmetic treatments, Dr. Roberts tells Dermatology Times.

"Out of the top 12 dermatologic diagnoses in elderly patients," Dr. Roberts says, "25 percent have a cosmetic solution."

Photodamage is a particularly common cause of skin damage in the elderly, she says. As such, Dr. Roberts says, "I use photodamage especially to spark conversation about prevention and rejuvenation."

That said, she emphasizes that one must not turn a medical visit into a cosmetic one.

"The doctor-patient relationship is built on trust," she says, "so cover the medical issue in detail, but discuss new technology and cosmetic options, as well."

For example, medical treatments for rosacea include topical and systemic antibiotics, as well as vascular lasers. "When I explain that to people," Dr. Roberts says, "they really get it."

This allows her to discuss both specific health issues and broader concerns related to aging, as well as how health and aging issues intertwine, she says.

"Aging skin may lead to unhealthy skin, possibly through decreased barrier function and/or UV damage," Dr. Roberts says. "Sharing that information with patients, as well as information about new technology and procedures, helps them understand why they may want to move into cosmetic treatments."

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