Dr. Downie is founder and director of image Dermatology in Montclair, NJ. She is on staff at Mountainside and Overlook Hospitals. A popular lecturer, she has made frequent media appearances, including on the Today Show.

Product dispensing is a significant and successful component of my practice. Convinced that appropriate skincare is essential for good skin health and optimal cosmetic outcomes, I have investigated various cosmeceutical ingredients and product lines over the years to select the best products to stock in my practice. I have educated my staff and my patients about the benefits of these products and have had many satisfied patients become long-term product purchasers.

Recently, however, I have encountered an increasing number of patients who have come to the office complaining about products they say they bought from my practice. These patients claim that products are underperforming or, in some cases, causing significant skin reactions. I have discovered that most of these products were not purchased from my practice and, in fact, where not the formulations they were purported to be. Some products were found to be diluted while some were clearly replaced with some alternative lotion or gel.

Unfortunately, my patients had fallen prey to some of the numerous online vendors of counterfeit cosmeceuticals. To make matters worse, my practice was at risk of paying the price.

Today's aesthetic practices must be aware of the problem of counterfeit cosmeceuticals, troubleshoot their dispensing program to safeguard against counterfeits, and establish protocols for managing patient complaints in order to protect both them and the practice.


The problem of counterfeit cosmeceuticals seems to be growing. As physician dispensers, we can be confident in receiving authentic products from approved vendors. In most cases, aesthetic specialists acquire inventory directly from product marketers, so there is no risk of a middle man tampering with or even swapping out product.

Unfortunately, some of us are willing to purchase products from unapproved vendors. The FDA's warning a few years ago to physicians who had purchased botulinum toxin from improper sources proves this sad reality. There's no telling what might actually be in products purchased from disreputable sources.

For most aesthetic physicians, thankfully, exposure to counterfeit products will not come from their own inventory. Instead, patients may unwittingly purchase counterfeit products from other sources, usually online. Do a Google search for the top cosmeceutical brands, and you'll find a host of sources claiming to offer those products for sale online—often at extremely low prices.

Patients enticed to buy these low cost products may find that they don't perform as expected. In some instances, however, they could actually cause harm. I have had patients present with skin reactions to products they purchased online. In one case, a patient's daughter's wedding was just a few days away when she presented with significant facial erythema.

Beyond the risk to patient health, the trade in counterfeit cosmeceuticals can hurt our practices. On the one hand, every dollar that a patient spends online for skincare products is money that he or she is not spending in your practice. It's a waste for them and a loss for you. The loss to the practice can be compounded if the patient tries to return that counterfeit product to your office for a refund. We have been on the losing end of these transactions in the past, and I and my staff are now attentive to this possibility.


To combat the problem of counterfeit cosmeceuticals requires a multi-pronged strategy. Patient education is a cornerstone. Any practice that dispenses cosmeceuticals should do so within the context of a comprehensive patient education program. Patients must understand skincare basics, as well as their specific skincare needs. If recommended products are intended to support the management of any specific medical or cosmetic concern, patients should be informed how and why the product provides benefit.

Part of patient education should focus on the fact that the products dispensed through the practice are unique formulations, specially formulated and tested. They have been vetted by the practice. I am proud of the fact that we have researched available options and picked the options we think are most likely to benefit our patients, and I share this fact with patients.

Make a point of explaining to patients that the products you offer are physician dispensed, and cannot be purchased online. Explain that there may be other lines and products available from the same brand or from other companies. Patients can feel free to try these alternatives, but they should not confuse these non-dispensed lines with the brands and lines you dispense. Cost should be a give-away. Explain to patients that they are paying for quality, you as a physician brand partner get fair prices from the brand, and any very low-cost option online is a fake. Liken skincare to knock-off handbags. Patients will get the analogy.

Just as important as patient education is the internal design of your skincare dispensing program. Work only with trusted brands that value physician partnerships and who offer products that are truly physician-dispensed only. The easiest way to protect patients from online counterfeits is to be able to tell them definitively that the product they get from you simply is not sold legitimately online.

Dispense only those brands that stand by their product and offer buybacks and refunds under appropriate circumstances. Even with the best product, there will be an occasional dissatisfied patient who deserves a refund.

Have protocols in place for handling product returns; extensively train all staff are on these. Our practices are not Target or Walmart, so patients should not expect a “no questions asked” return policy. To reduce any appearance of patient mistrust, simply tell patients that you want to know more about their experience so you can better manage your dispensing and patient care. Ask why the patient is returning the product, how long they used it, etc. If the patient reports unusual and unexpected problems with a product, staff should be skeptical.

If your dispensing program is good, you'll have a purchase history for every patient. Make sure they ever actually bought the product in question from you. Also, check the last purchase date. Allowing a product to expire is not an acceptable reason for initiating a return. If the last purchase was several months ago, consider that they may have bought product elsewhere in the interim.

Never accept for refund any product that the patient did not buy from you. When dubious situations arise, staff members can ask, “Are you sure this is the product you bought from us?”

Establish a policy for review of nebulous cases. The physician or the practice manager can make the call whether it is worth losing a few dollars on a questionable return to retain a loyal patient. The reality is that this scenario is unlikely. My loyal patients know me and respect me and my practice. While that may not preclude them from trying to benefit from an online deal, I believe that most would be honest with me and admit that the problem product wasn't sold in my practice.

Finally, make sure that your dispensing program is fairly priced and service-focused. Make it easy and convenient to make in-person purchases and offer phone ordering with shipping for those who cannot make it into the office. This way, patients are less likely to turn to the Internet in the first place.


The growth of counterfeit cosmeceuticals has threatened to complicate the practice of dispensing. However, as long as practices are aware of the problem and take the proper steps to update their approach to dispensing, this potential nuisance is easy to overcome. The key to success is simple: Give patients plenty of good reasons to buy their products from you and allow them no good reason not to.