In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with Collin M. Blattner, DO, FAAD, about perspective-changing complications, the future of aesthetic conferences, and the importance of allied health care providers.
Welcome to “Meet the Aesthetic Expert,” where, each month, dermatologist Will Kirby, DO, FAOCD, of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.
Collin M. Blattner, DO, FAAD is a double board-certified dermatologist and fellowship trained Mohs Micrographic Skin Cancer Surgeon. His passion for surgical, pediatric, and medical dermatology is evidenced though his authorship of over 50 peer reviewed publications in highly regarded journals such as the Journal of the American Academy of Dermatology, International Journal of Dermatology, Journal of Cutaneous Pathology, Cutis, Dermatology Online Journal, Pediatric Allergy & Immunology, and Clinical Pediatrics. He has also written 6 dermatology textbook chapters and serves as a reviewer for the Journal of the American Academy of Dermatology.
K: It's interesting that you brought up the fact that it was once extremely difficult for DOs to obtain dermatology residency training. How has that changed?
B: At one time it was nearly impossible for an osteopath to get dermatology residency training as the programs were all historically allopathic. So, the DOs started their own residency programs. Relatively recently though, the ACGME [Accreditation Council for Graduate Medical Education] residency pathway makes it more equitable for DOs to obtain residency spots in all specialties. However, I’m afraid that by combining MD and DO residencies, it might make it even harder for DOs to get competitive dermatology residencies. More will be revealed.
K: What resources (technology, human resources, staff education, marketing, etc.) should aesthetic providers invest in right now?
B: Hiring a human resources director was an amazing practice investment. They handle all day-to-day problems and make sure that you are completely compliant with OSHA, HIPPA, CLIA, and much more. In medical school, they don’t teach you about regulatory bodies so it’s great to have someone on your team who knows this vital information.
K: What aesthetic patient demographic do you believe is the most coveted? Is this shifting?
B: In my experience we have found that women in the age range of 30 to 60 are willing to spend money to enhance their appearance on aesthetic dermatology procedures. The demographic does seem, anecdotally, to be shifting younger.
K: Telehealth exploded during the pandemic. Is it here to stay?
B: Dermatologists, as a general rule, are visual and we have found that for my patient population at least, most people prefer to be seen in person instead of over a computer screen. That said, you can’t put the genie back in the bottle and telehealth, in some way, shape, or form, is here to stay.
K: Why do so many people feel that the aesthetic industry is ripe for disruption?
B: Some of the older dermatologists are absolutely phenomenal aesthetic practitioners but it may be time for others in this group to phase out of aesthetic practice as there is a desperate need for innovative techniques, novel ideas, and new providers. See, the aesthetic industry has only been around for 20 years, so the truth is that some of the older physicians currently practicing are really self-taught and the millennial population might not want aesthetic care from providers who aren’t in their same demographic.
Let’s think about it this way: Did many dermatologists who are currently in their 50s have comprehensive aesthetic training during residency? Very unlikely. Afterall, how could they? Botox Cosmetic and laser hair removal, 2 of the original aesthetic treatments, have only been readily available for the past 2 decades. Many industry professionals feel that the industry is ripe for disruption because some physicians haven’t kept up with aesthetic training and the large number of patients already seeking aesthetic treatments in the marketplace aren’t always having their needs met.
The current group of aesthetic providers available in the United States simply might not have the bandwidth, training, or aptitude to meet this anticipated surge in patient demand that is just starting. More education, better protocols, and additional aesthetic providers are needed. As such things change, disruption is extremely likely.
K: What role do you think allied health care professionals (RNs, NPs, PAs,) will play in this disruption?
B: I work with 4 amazing clinicians; I personally trained them, I know their capabilities, and they know to immediately contact me for advice if they are uncertain about a situation or need guidance. This level of communication protects the practice and the patient. I suspect that many physicians are afraid of allied health care professionals though because they fear replacement as a new generation of providers rise. This is a fear-based mindset however as I’m of the personal belief that clinicians are just solid additions to a dynamic and diverse care team. Allied health care professionals certainly do not have the advanced training necessary to read histopathological slides or perform Mohs surgery. This is what makes some fellowships so important and the reason that well-trained dermatologists will always be in high demand.
K: But why are some physicians who specialize in aesthetics so threatened by the allied health care professionals in aesthetics?
B: Well, one reason that some physicians might fear allied health care professionals comes down to the concept of forced attrition. Outside forces beyond their control are changing the aesthetic landscape and these physicians are worried they will be replaced. And I do understand this fear. I had this exact concern once! I was afraid of letting the clinicians I employ do aesthetic treatments. But, with proper training as well protocols and procedures, everything has become standardized and the aesthetic care that providers in my clinic give patients is top tier.
There is also a lot of hypocrisy. Many aesthetic dermatologists who lobby against expansion of duties for allied health care professionals actually employ allied health care professionals themselves.
K: Fair points. Moving on, what is the biggest myth in the aesthetic industry?
B: I’ll give you 2: One of the biggest myths in aesthetics is that a patient has to spend big money to see big results. We offer things like Botox Cosmetic and microneedling; inexpensive treatments that offer amazing results. The other myth is that you always have to have the latest technology. Many aesthetic providers forget that some of the older technology works extremely well. Medium and deep chemical peels, as an example, can be the perfect treatment for the right patient!
K: Whom or what do you fear in the aesthetic industry?
B: I fear that the price of Botox Cosmetic will keep going up! Allergan Aesthetics keeps raising the price year after year after year and I think it has caused a lot of practices to switch to the other 2 top neuromodulators, Xeomin from Merz and Dysport from Galderma, which offer very similar clinical outcomes. And more new neuromodulators are coming down the pike eventually too. Allergan Aesthetics has great products, incredible heritage, and much, much more research and development than any of their competitors but they might need to acknowledge that their market is getting a little crowded. They might want to hold off on price increases or risk alienating their current physician customers and losing some of their large market share to other aesthetic brands.
K: What keeps you up at night?
B: The thought of having a serious filler complication. I have never personally had one but trust me when I tell you that I have seen them. The complications usually come from under-trained practitioners injecting into dangerous areas. These unfortunate patients occasionally end up in my office after having a bad experience somewhere else and need specific care from a complication that could have been avoided.
K: This is probably uncomfortable, but do you mind getting more specific? Maybe without using any names, tell us about a specific aesthetic adverse event suffered by a colleague of yours that made you rethink your own practice.
B: A colleague of mine injected filler in a patient’s glabella and, tragically, blindness was the outcome. I will never forget the nightmare that the provider and patient went through. This event taught me to stay cautious, treat conservatively, and focus on human anatomy. Injectors on social media push the boundaries too far and the consequences can be severe.
K: What can we do to promote transparency in aesthetics?
B: I think we should embrace open discussions and encourage new voices to participate in industry meetings. The current aesthetic meetings feature the same people over and over and a lot of the best practitioners now eschew meetings as they are afraid to share their “secrets” since they think someone else will “borrow” their proprietary techniques and have nothing to learn from the same mediocre speakers who are always on podium. I personally love talking to other dermatologists about how they practice aesthetics since everyone has a unique formula and so I’d love to see a more diverse group of presenters at aesthetic meetings. Improved communication and fresh perspectives would be a much-welcomed breath of fresh air that our industry desperately, desperately needs. Aesthetic meetings will either evolve for the better or, for the ones that remain in their current form, slowly go extinct.
K: What advice do you have for people in the aesthetic space to avoid burnout?
B: For me, taking time off gives me energy to think about what’s important in life. I have a new baby on the way, so I have been trying to get our clinics perfect before that arrival. The other thing that is often forgotten is to focus on the good patients. We all have patients who can drain you, but you need to focus on the 99% of patients who are appreciative and grateful for what we do for them.
K: Great point! And congrats on the baby! Now, as an expert in the aesthetic industry in a powerful position, people are looking at you to lead. If you could inspire a movement in our industry, what would it be?
B: An area of unmet need that will absolutely grow with time is male and female pattern hair loss. PRP and FUE hair transplantation is only the start. There have been great articles about using Botox Cosmetic and mesotherapy with dutasteride for the treatment of androgenetic alopecia. I’d like to be a part of that movement.
K: Interesting. And what is your favorite aesthetic treatment to personally receive?
B: I love PRP for hair loss. I started losing some hair on top at around 25 years old and it really bothered me. So, I always ask my male patients if it bothers them. 30% of men will lose hair by the age of 30 and it is very common, but male patients don’t talk about it openly because of social stigma. I think we need to become much more comfortable addressing these concerns. Also, hair transplant technology is amazing these days and can be a great avenue for guys who are past the point of medical management. Gone are the days of hair plugs since we now have FUE hair grafts.
K: What advice would you give your younger self knowing what you know now?
B: Start dutasteride earlier!
K: That’s hilarious! What is your favorite quote (mantra, etc.) that is applicable to the aesthetic industry?
B: “Expectations are the start of disappointment.” So, always set realistic expectations with your patients.
K: If you weren’t an aesthetic expert, what would you do for a living?
B: I would be making pottery. I’ve always loved abstract art and I think that I would be working in a gallery somewhere. Rothko is my favorite painter and I always thought it would be cool to be a museum curator or work as an art dealer.
K: What is something interesting about you that you have never before publicly revealed or isn’t widely known?
B: I love Yorkies; the smaller the dog, the more I love them!
K: Name drop an individual that represents the future of our industry and maybe they will be the subject of a future interview!
B: Craig Kraffert, MD, who founded DermStore.com many years ago. He now owns Amarte Skin Care which is an amazing line of products.
K: Dr Blattner, thank you so much for your candid words. As someone who conducts many interviews and knows that aesthetic experts fear industry retribution for being transparent, I truly appreciate how forthright you were today. Your openness is much appreciated! How can readers get more aesthetic expert information from you?
B: Please find me on social media at @clearchoicederm.