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Tips for integrating cosmetic procedures


New Orleans — Cosmetic procedures can be successfully added to a dermatologic practice if the process is done in smaller, incremental steps. Dermatologists should be pursuing cosmetic procedures and leading the way for patients to receive safe and esthetically pleasing cosmetic results, according to Sarah M. Boyce, M.D., assistant professor in the department of dermatology and director of cosmetic dermatology at the University of Alabama School of Medicine in Birmingham, Ala.

At the 63 rd Annual Meeting of the American Academy of Dermatology (AAD) here, Dr. Boyce offered suggestions and advice on how and why dermatologists should integrate cosmetic procedures into their established dermatologic practices.

"If dermatologists do not lead the way in this movement, then people who are less qualified than we are will take charge of this, and that won't be good for anyone," Dr. Boyce says.

Taking steps The incremental steps that Dr. Boyce recommends should be taken in a conservative manner. She suggests learning cosmetic procedures that do not require expensive equipment and are less complicated, such as injections of collagen or botulinum toxin type A (Botox, Allergan). Superficial chemical peels are also a good place to start.

New equipment purchases should not be financially draining at the outset, and a microdermabrasion machine is a good initial choice. She cautions against buying a laser as a first step, due to its high overhead costs and the self-imposed pressure to recoup those costs from hundreds of office visits.

Dr. Boyce says overhead costs are a significant factor to consider when integrating cosmetic procedures. Such costs can diminish the profits that some dermatologists optimistically expect with cosmetic procedures.

"It is not a slam dunk. Doing cosmetic procedures is not a guaranteed gold mine," she warns. "A lot of purely cosmetic practices run at a much higher overhead than general dermatology. The margins are higher, but overhead can be higher, too."

To help dermatologists learn new cosmetic procedures, Dr. Boyce refers to the cosmetic courses available through the AAD and the American Academy of Cosmetic Surgeons.

She also strongly recommends pursuing mentorships with established cosmetic surgeons to observe their techniques and discuss their experiences with the procedure.

"It can be costly but worth it because you are learning from an expert."

In general, she says it is a good idea to get feedback from an experienced cosmetic dermatologist before taking the plunge into the cosmetic arena. Talk over your plans to integrate cosmetic procedures with someone who has experience, and get their viewpoint.

"Most of what I have learned has been from other people who have done it before me. Do not make a decision blindly without the advice of someone who has done it before," Dr. Boyce advises.

And that decision-making process should include office personnel, who she says can make or break your venture into cosmetic procedures. Dr. Boyce suggests an interactive dialogue where you explain the changes and staff members can voice their concerns.

Among the differences dermatologists may experience when cosmetic procedures are integrated into a dermatologic practice, Dr. Boyce says a change in the duration and pace of office visits could be considered a benefit or a drawback. Because cosmetic patients require more time for counseling and may sometimes have an office visit that combines counseling with the desired cosmetic procedure, dermatologists can slow down and "be more relaxed," she says. However, other dermatologists might feel the longer appointments decrease the office's daily productivity.

If possible, she recommends allocating blocks of appointment times - perhaps a half day - to cosmetic patients so that the dermatologist's mindset is focused in one direction and not jumping back and forth between difficult medical dermatologic problems and cosmetic procedures.

Results-oriented dermatologists may find that performing cosmetic procedures is more gratifying because patient outcomes typically are visible more quickly than in clinical dermatology. Other dermatologists can benefit, as well.

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