By Steven Dayan, MD

Steven H. Dayan, MD, FACS is in private practice ( in Chicago. He is a Clinical Assistant Professor at the University of Illinois and author of the book Thrive.

There have been numerous think tank sessions throughout the last year wherein non-medical personnel, alongside number crunchers, a few physicians, and a host of others with less defined motives, have attempted to better understand the aesthetic patient. These incubators are tasked with helping to define the psychographics and desires of aesthetic patients along with how to best meet their goals. A common debate surrounds determining the barriers to entry for the large majority of Americans who have expressed interest in aesthetic treatments, yet remain resistant to taking a leap forward toward actual treatments.

The Aesthetic Climate

Current trade winds gust that aesthetics is a great field to get into. There is little debate that we are witnessing a seasoned baby boomer population merging with a maturing Gen X population, all very motivated and empowered to look their best and willing to splurge to attain it. The global aesthetic market is expected to grow 11.5 percent per year up through 2016.1 In the eye of a stormy medical environment where regulatory bodies are increasingly defining the parameters of medical care and the codes of practice in medicine, aesthetics—with its intact doctor patient relationship, lack of perceived regulatory control, and a cash basis—has become an attractive oasis for not only medical students and residents choosing a specialty that is professionally fulfilling but also for non-core physicians wanting to have access to the same privilege and of course the potential for “fee for service” patients.

Large pharma companies, healthcare attorneys, and other would-be opportunists want a safe haven to hedge against the overly bloated healthcare economy. They see aesthetic patients, physicians, and medicine as an opportunity for unencumbered earnings.

But perhaps their eyes and minds are deceived by a foggy mirage rather than a palm tree-laden refuge. The commonly quoted and cited market research consistently shows that aesthetics is a highly underpenetrated market, with only five percent of the eligible population actually getting cosmetic treatments. It is surmised that there are another five times potential that would consider a treatment but are hesitant.2 Additionally, we are reminded repeatedly that there is a large male market that has not yet been addressed. To a big-thinking economic speculator this is a ripe field to be reaped.

Bottom Line

As we move forward into a new era of aesthetic medicine, it is becoming increasingly clear that outcomes are more than just form and function but also mind and mood. Physicians should therefore shift toward meeting patient expectations when it comes to the experience of medicine rather than just aesthetic endpoints.

The traditionally myopic thoughts of industry seem to focus on the next best innovative product as the most direct way to get more people in the game. Therefore, old guard strategists, in an attempt to entice those at the back of the room, seem set on finding or creating the perfect pill, filler, toxin, or topical to wipe away wrinkles, fill in hollows, and tighten skin with the belief it will nudge the interested onlookers on to the dance floor.

Manufactured “in vitro” market research studies conducted in sterile boardrooms polling patients and doctors on what it would take to get more interested but skeptical prospects to come in for aesthetic treatments will mostly default to suggesting lower prices. But lowering our prices can be a costly gaffe. Certainly, many professional providers as a group have taken the low road and lowered price (can anyone say $5 dollar a unit bargain price?) in an attempt to attract more volume, but as any economics 101 student can tell you, we risk destroying the value, market, and ourselves eventually by commoditizing aesthetic physicians and the care we provide. Additionally, industry is steadfast against lowering price as it hinders their profit margins. And there are numerous examples of consumers paying a higher price, validating their purchases if the perceived value is worth it… otherwise how could anyone explain the success of a Pet Rock sold at nature shops, Nike gym shoes in depressed economies, and overpriced lasers in doctor's offices?

Another frequently heard request by physicians in vitro suggests that if industry would just increase their spending on direct to consumer advertising it will persuade more potential patients to visit our offices asking for a solution to their frown lines or parentheses or maybe how to get a little blue pill. However, assumes the patient doesn't turned off by the fine print and spoken warnings of diarrhea, dementia, and death.

Barriers to Overcome

I would suggest that for those of us in the trenches every day meeting, speaking with, and attentively listening to our patients and their desires, the “in vivo” barriers or hurdles to expanding our reach and enticing new patients to visit our offices or enter into the market are different than what are the stated canons.

Ahead are four major hurdles that physicians practicing aesthetic medicine must individually and collectively leap past in order to expand our footprint, improve our positioning, and increase our relevance to the prospective patient/consumer.

1. The fear of appearing unnatural.

“I want to look natural!” Our patients have been screaming this for the last two decades, and yet we have failed to respond effectively. The average person on the street (i.e., someone who doesn't live in our cocoon of aesthetic medicine) believes that anybody who gets plastic surgery or cosmetic procedures is destined to be noticeable and look unnatural. Unfortunately the recognized poster children for cosmetic surgery are Joan Rivers, Michael Jackson, and Kenny Rogers.

The silent majority is surprised to learn that there are many people who actually can have plastic surgery, injectables, and other aesthetic procedures and look natural. We investigated this premise by going onto the streets of Chicago and asking random people their thoughts on plastic surgery. (

In order to turn this ship, we have to define what is a natural result, and then teach and train on how to achieve a natural result. I would suggest this is a three- to five-year project culminated in a detailed campaign supported by facts (papers, studies, testimonials), all rolled up into a well fueled campaign crowning well trained and boarded aesthetic providers as the purveyors of natural outcomes.

2. Pain

A common issue glossed over in aesthetics and arguably in all of medicine is the influence that pain has on treatment outcomes. Frequently, patients known to the practice may squirm through, delay, or cancel an appointment because they are just not in the mood for “a shot.” But how many prospective patients in the wake won't even entertain seeing an aesthetic physician because of a disproportionate fear of pain? This is an unknown that the market researchers and economists cannot readily quantify but it has to be a sizeable group. And as a specialty, there is an unacceptable dearth of studies and papers in our field addressing this issue. Additionally, if we can reduce or significantly remove pain from our treatment, I argue that many more people would consider a treatment.

Two of the most popular office based treatments—toxins and fillers—accelerated in popularity while being modified to reduce discomfort (diluting toxin with preserved saline and the addition of lidocaine to the filler). Was their steep climb on the growth curve just coincidence, or could perhaps the reduction of discomfort have led to greater word of mouth endorsement for the products? Also an intangible that cannot be defined is the impact a pain-free procedure has on our office environment and goodwill. A satisfied, anxiety-free patient likely leads to a happier workplace for both the doctors and the staff. Let's make a concerted effort to reduce the discomfort of procedures and not just “talkaesthesia.” From vibratory distraction to nitrous oxide, to topical and injectable nerve blocks and more, dentists have mastered this initiative. Perhaps we should take a closer look at how to mitigate pain as well. Could you imagine the popularity in your practice if you could promote yourself as the pain-free doctor?

3. Post-treatment morbidity

Many patients refuse to come in, delay their procedure, or alter the timing of an appointment because their fear of being bruised and swollen. Whether it is plastic surgery, fillers, or laser procedures in our 24/7 modern world of instant gratification and constant communication, the ability to “unplug” for a week is not easy, regardless of age and certainly likely to become even more of an issue.

Do This Now

Look around your waiting room and consider ways of making it more patient-friendly. A waiting room filled with people interested in perceived “vanity” can be discomforting. Small measures to reduce clinic place anxiety can go a long way to creating a welcoming environment attractive to the apprehensive.

If we as a field can study and commit to developing protocols to reduce morbidity with better technique (e.g., blunt tip cannulas, slower injection, less invasive surgery, pre- and post-treatment nutritional supplements, ecchymotic reducing light based treatments, etc.), we can remove or reduce a major hindrance for our current patients and a barrier to potentially new patients interested in cosmetic treatments but who fear the downtime.

4. Intimidating office setting/accessibility/convenience

We likely all walk into our offices nonchalantly every day with blinders on as we focus in on the daily task list at hand, but if we were to pause for a second and commit to step in the shoes of our patients, I think we would realize that walking into a cosmetic practice office can be intimidating. A waiting room filled with people interested in perceived “vanity” can be discomforting. As one paper noted, it is not the plastic surgeon nor their skill level but rather how the patient was communicated with that most correlated with the success of the outcome and visit.3 Small measures to reduce clinic place anxiety can go a long way to creating a welcoming environment attractive to the apprehensive.

Toward a New Aesthetic Medicine

We are in the midst of an aesthetic medical revolution. We have all benefited from the explosive popularity of office based non-surgical treatments which have increased awareness for our trade, expanded our market of patients and the scopes of practices. These treatments have also given us the ability to conduct placebo randomized controlled trials and develop evidence based medical protocols to better understand what we are doing and why. And likely it has led us to become better at what we do. Our treatments are becoming more effective, and results more consistent.

Now as we move forward it is becoming increasingly clear that outcomes are more than just form and function but also mind and mood. And as the measure of our success gets shifted toward meeting the patient's experience expectations as well as their aesthetic ones, new targets for study are in our sights. Aesthetic medicine is on the precipice of a new generation, and this one's demands will require us to look past the obvious to truly understand what makes a patient happy and why.

1. Medical Insight inc. Global Aesthetic Market Research report March 2012.

2. Valeant Pharmaceuticals: Aesthetics Market quantitative research Sept 2014; Commission File No. 001-14956

3. Chung KC, Hamill JB, Kim HM, Walters MR, Wilkins EG. Predictors of patient satisfaction in an outpatient plastic surgery clinic. Ann Plast Surg. 1999;42(1):56-60.