Contributors to Modern Aesthetics® and MATV frequently mention the commoditization of cosmetic medicine. But what does that mean to your practice? The aesthetic landscape is full of physicians and non-physicians, many who have never worked or trained in any core cosmetic field, advertising discounts and rock-bottom prices. They can do so because they function without the overhead inherent in a high-end core cosmetic practice (including all the costs of remaining board certified in our core fields). Patients have also become used to referring to “providers” instead of doctors, as third-party payers try to make nurse practitioners and physician assistants indistinguishable from physicians (when nurse practitioners get a PhD, some even use “Dr.” in front of their names). The public is left with the impression that the procedure IS that product or laser, independent of the provider, no different than a pair of sneakers you can buy at a selection of stores. So how do core cosmetic physicians survive?

First and foremost, it is critical to educate the public about the dangers—medically and aesthetically—associated with having procedures in the wrong setting by the wrong provider. It is a fine line—we do not want to scare patients away from treatment. So the message must be given in conjunction with branding our specialties as the true experts with the highest level training. Training means a better outcome. Training means expertise in evaluation in order to choose the most appropriate path for that individual and expertise in doing or supervising those procedures. Often patients complain that they did a procedure elsewhere because of a great deal, but feel the money spent was wasted because it didn't accomplish their goals or because the treating office couldn't or wouldn't handle a side effect or complication. Even if our staff is performing laser hair removal or noninvasive fat reduction, it is our responsibility to make sure they do it well, and to handle anything that goes wrong. So we are the ones who can maximize aesthetic results while minimizing complications.

The next hurdle is separating the product from the pricing. Direct-to-consumer advertising tells people to see their “health care provider,” not their plastic surgeon, dermatologist, oculoplastic surgeon, or facial plastic surgeon. Doctor finders for pharmaceutical and device companies are generally organized based on who buys the most, not necessarily who is the best option. One of the largest customers of filler and toxins in the US is a spa chain run by a non-core physician. Remind patients that it isn't the paint or the paintbrush, but the painter who makes a Rembrandt a masterpiece. So facial rejuvenation at the doc-in-the-box or hair dresser around the corner is not the same as facial rejuvenation in your office, even if the disposable supplies come out of the same box.

Credentialing is an essential tool in helping to distinguish ourselves as experts and in encouraging patients to focus on the quality of treatments over the cost of those treatments. Train—and re-train—staff on what to say and how to introduce it during patient interactions from casual inquiries to consults. They should mention facts about your expertise, as well as that of any physician extenders in your practice. Depending on how close you are to training, they can focus on how and where you trained, your number of years in practice, number of patients treated, your participation in clinical trials, advisory boards, or academic meetings related to the procedure being discussed. Have the information online but also remember that diplomas, bios, and press books are helpful in-office tools.

When you and your staff speak with patients, avoid the hard sell. Take the time to educate patients about the risks, benefits and expected outcomes of proposed treatments. Establishing realistic expectations goes a long way to solidify patient trust in you as an expert who cares more for a patient's best interest than the bottom line. Some of the longest-term and most loyal patients are those who you recommended not have a given procedure because it wouldn't move them significantly toward their aesthetic goal. And the patient you send out to another office for a procedure you don't do but think is best for them may be one of your best advocates because you were honest.

There are effective ways to offer special pricing to patients to drive your business forward without diminishing your worth. For example, consider bundling procedures, where patients can save money by opting to have multiple procedures done in one visit rather than individually. Or offer package pricing for a series of treatments, especially if you know the patient will have better outcomes from more than one treatment session or more than one treatment area. If you are the first in the area to offer a treatment or procedure, introductory price points can bring in new patients and establish you as cutting edge. If you are training residents or new physicians, offer teaching pricing. You're acknowledging that there is a lower price point for less experienced physicians, while enhancing your brand as an expert who teaches and trains. These are win-wins for physician and patient.

Finally, remember that we are providing a luxury—just like The Ritz Carlton, Bentley, or Hermes. Those brands command high prices because they are valued. Value yourself, provide valuable care, and your patients will value you.

Co-Chief Editors

Heidi Waldorf, MD, FAAD, and Steven Dayan, MD, FACS