Incorporating cosmetic procedures into Mohs practice

Scottsdale, Ariz. - Mohs surgeons are adding cosmetic procedures in their practices. For the beginner, sometimes this feat may seem more difficult than it really is. Leonard H. Goldberg M.D., F.R.C.P., who practices in Houston, explained just how simple the leap in the surgically challenging world of cosmetic procedures can be, at the American College of Mohs Micrographic Surgery and Cutaneous Surgery and Cutaneous Oncology meeting, here.

The skilled Mohs surgeon is quite competent to perform any aesthetic procedure that can be done under local anesthesia. These include blepharoplasty, liposuction, facelifts, scar revision, Botox injections, fillers and laser procedures.

There are several reasons why the Mohs surgeon may choose to perform aesthetic procedures.

"Doing different procedures and learning new techniques is exciting and offers new challenges. I get gratification from performing these procedures well, doing beautiful surgery and getting excellent results from the patients. Together with my colleagues in my practice, we have been able to develop a comprehensive cosmetic array of procedures to offer our patients," he says. "We are able to satisfy the needs of our patients concerning aesthetic goals and improvement."

Learn procedure first

Before attempting new procedures, it is paramount that the surgeon learns all about them. This includes how to handle potential complications, as well as how to recognize the usefulness and limitations of procedures.

Dr. Goldberg asserts that it would behoove the Mohs surgeon who wants to add these cosmetic procedures to his practice to first learn from the experts.

He says that one could first read about the procedures in textbooks, watch videos, and then attend an American Society for Dermatologic Surgery or Mohs College course or a cadaver course.

An excellent way to start the ball rolling is to simply spend one to two days observing colleagues doing the procedures in their practices. This way, one can see firsthand which new techniques leading surgeons employ. Dr. Goldberg mentions that one can begin by finding some volunteers for free service, perhaps by asking staff or relatives.

Incorporating procedures

After deciding which potential procedures are to be incorporated into a practice, the next steps include marketing, creating brochures, creating a portfolio for "before" and "after" pictures; creating pre- and postoperative patient instruction sheets, and considering billing issues. All these issues play an important role.

Dr. Goldberg says, "A major difference between Mohs surgery and cosmetic surgery is that we do not select our patients with skin cancer; whereas in cosmetic surgery, careful selection of the patient to suit a particular procedure is important. We must not operate on cosmetic patients who have unrealistic expectations for what a procedure can do for them. Skin cancer patients are very grateful with the removal of the skin cancer and may have less expectations cosmetically, whereas cosmetic patients' expectations from a surgery are primary in their mind."

Natural progression

Scar revision could be the first potential steppingstone for the Mohs surgeon in incorporating aesthetic procedures into a practice. Dr. Goldberg says the aim of scar revision is to "simply" improve a surgical scar. The cosmetic reasons for this procedure are clear for both patient and surgeon. Dr. Goldberg says undertaking a procedure like scar revision can give the Mohs surgeon a taste of the cosmetic interaction. These patients are readily available in the Mohs practice.