Modern Aesthetics | Joining Forces: Working with Non-Aesthetic Providers to Optimize Care
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Joining Forces: Working with Non-Aesthetic Providers to Optimize Care

Why I agreed to build a new practice in conjunction with an ophthalmologist to offer the best range and quality of care to patients.
By: Sheila Barbarino, MD


Originally trained as an ophthalmologist with the goal of specializing in oculoplastic surgery, I did two additional fellowships: one in full body cosmetic plastic surgery and one in full face plastic surgery.

My evolution into full-face and body cosmetic surgery was driven by patients. I recall a post-operative blepharoplasty patient who was so thrilled with her outcomes that she asked me to do a full-face lift and then inquired about liposuction. I trained with an oculoplastic surgeon who also had trained in cosmetic plastic surgery; I saw him doing breasts and facelifts and noses. He advised me to pursue plastic surgery fellowships.

I completed those fellowships, and I board certified in cosmetic surgery. I started my own practice and surgery center in Hermosa Beach, CA. While that practice has been successful and rewarding, family commitments required that I relocate to Austin, TX.

Our Model and Why it Works

As I began investigating options in Austin, the chair at my hospital suggested I reach out to Steven Dell, MD, an ophthalmologist whose practices focus on ocular surface disease, premium IOLs, and LASIK. Dr. Dell had noticed that a substantial proportion of his patients are interested in the very cosmetic services that I provide. He suggested that we join forces, and he brought me in.

Partnering with an ophthalmologist makes sense on multiple levels. There is tremendous crossover between constructive and cosmetic surgery. I recognized that learning various cosmetic techniques could help with overall patient care. For instance, when we have patients that have an eyelid droop but does not want to have further surgery, we can place filler in the lower lid margin.

Conversely, when I do eyelid surgery or brow lift, ocular health is primary. Prevention of dry eye and/or preoperative management, is essential. If I send the patient to Dr. Dell to have their eye worked up and managed first, then I am going to have that much of a happier patient after I do their eyelifts or their brow lift.

Essentially, our model is based on a truly multi-specialty group that can address every facet of the patient’s needs. Every group that is not doing this now should think that way. We really are building a practice within a practice versus just expanding the traditional medical eye group.

There may be practice efficiencies, too. For example, several laser companies offer devices with cosmetic and medical uses. Dr. Dell may need CompanyX’s laser for the anterior segment, and I need their hair removal device. We can negotiate better terms when buying together.

Old models of practice development are giving way to new strategies for patient engagement. Practices no longer hire physicians to “handle the overload” of patients. Instead, most physicians want to retain their patients and bring on new partners to further grow the practice’s base. Patients, for their part, are becoming savvy, and loyalty is no longer assumed. They can research providers online, they talk to friends, and they can even pursue non-medical sources for some procedures. This puts more pressure on practitioners to attract and retain patients. Bringing two (or more) specialties together in practice is a great way to grow that practice base and create opportunities for mutual growth.

Special Considerations

It should be noted that aesthetic practices and medical ones are different. For one, practices seem to grow at different rates. The growth rate of a cosmetic practice is a lot quicker; People tend to readily flow into aesthetic centers. Our aesthetic practice is fully integrated with but still separate from the medical practice. This is important. The key to success in aesthetics is to provide a top-notch experience that keeps patients coming back. Aesthetic patients, for example, do not like to wait. And they don’t want to sit in a medical waiting room with “sick” patients. The same patient who might wait patiently for a medical eye appointment may become dissatisfied with even one-tenth of the same wait in an elective cosmetic setting.

An Option to Consider

This is an exciting time to be in medicine, especially aesthetics. The population is getting older but staying healthier, and everybody wants to look the way they feel. As more physicians begin to dabble in cosmetic procedures, core specialists may find that the option to partner with non-cores is an attractive opportunity. If they can go to a practice that they know and trust already from doing their eye exams or eye management, patients could be more likely to actually book a cosmetic procedure and become a long-term cosmetic patient. An aesthetic and a medical practice can grow both together and individually.

Sheila Barbarino, MD, FAAO, FAACS, FACS is an oculoplastic surgeon in practice in Austin, Tx.