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Since we place all our "mole check" patients in gowns, it was easy to evaluate the patient's leg veins during the visit.

Editor's Note:

In this special feature, Joel Schlessinger, M.D., F.A.A.D., F.A.A.C.S., offers his advice on handling questions frequently asked by patients seeking anti-aging procedures. The president of the American Society of Cosmetic Dermatology and Aesthetic Surgery, Dr. Schlessinger is a member of Dermatology Times' Editorial Council. He is in private practice in Omaha, Neb., and is the founder and owner of http://LovelySkin.com/. Dr. Schlessinger also contributes a regular column to "In the Know," Dermatology Times' quarterly patient supplement, the second issue of which appears this month.

Q: The patient says she liked the last IPL procedure, but now is developing brown spots on her right cheek. She asks what she can do.

A: While this may seem like an easy question, it contains several inherent "loaded questions." For example, it can sometimes mean that the patient is dissatisfied with the previous procedure. It can also mean that he or she expects this treatment to be free. We answer these in the consent form by stating that if patients have additional procedures, they are paid procedures.

In this patient's case, we performed another IPL procedure with the Starlux (Palomar) IPL on the entire face, rather than specific areas where IPL had previously been performed. By doing this, we expanded a previous treatment and introduced the possibility of other treatments in the future.

Q: The patient says she has leg veins and wants to know what she can do.

A: Since we place all our "mole check" patients in gowns, it was easy to evaluate the patient's leg veins. After a brief exam, it was decided we would perform leg vein treatments as well. In our clinic, we do both laser (Starlux 1064) and sclerotherapy.

In some clinics, the "Oh, by the way ... " question is unwelcome, while in our clinic, it is encouraged. Although the procedure may tend to throw schedules off, the patient is in the office and interested, making this the perfect time to address such a request. In the past, we found that many patients would schedule an appointment and would either not show or cancel if the procedure wasn't done at the time of the visit.

Aside from the unplanned timefactors, another downside to this method is the potential need for more staff. However, the increased income may outweigh the extra staff pay. Each practice must decide this case-by-case.

Each of my visits ends with me asking whether the patient has any other questions or concerns. Many times the patient will ask about cosmetic procedures or the referral of a friend or family member. This is the equivalent of when the McDonald's worker asks if you want to supersize the order. Frequently such a patient is financially helpful to the practice.

Q: The patient inquires whether leg vein treatments are covered by insurance.

A: We tell our patients that spider veins aren't covered by insurance. We have a very good relationship with a vascular surgeon who does the varicose veins and will bill insurance. While I realize that many dermatologists do endovenous ligation, we found that the reimbursement and risks were unfavorable and the potential for insurance-related denials and/or inadequate reimbursement made this procedure less appropriate for our clinic. That doesn't mean this is true for all clinics, but in ours it makes sense.

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