Bolstering Business with Neuromodulators

For better or worse, our new virtual world is actively shaping our personal and professional behavior. Video conferencing has not only changed the way we engage in communication, but it also means that, despite physical distancing, we continue to see each other—and ourselves—in a new and dynamic way.

Day in and day out, we’re watching ourselves animate—talking, moving, laughing—and many of us are seeing new lines, wrinkles, and dimensions to our faces that we may not have noticed before. As a result, a growing number of people are seeking different and more noninvasive cosmetic interventions, including neuromodulators to reduce wrinkles and fine lines, injectable fillers to restore facial fullness, and laser treatments to treat acne scars, rosacea, or sun damage.¹ In 2019, the American Society of Plastic Surgeons marked the highest number of Botulinum toxin type A injections to date with more than 7.69 million injections, and the demand for facial rejuvenation procedures did not show signs of slowing down in 2020. In fact, US physicians saw a 64 percent increase in telemedicine consults for cosmetic procedures during the pandemic.²

Like many other businesses, medical offices throughout the country were forced by the medical board to close or postpone elective procedures in an attempt to help slow the spread of COVID-19. While these precautions were undoubtedly necessary, closures resulted in a loss of revenue. However, 68 percent of 350 American cosmetic surgeons have seen a heavy stream of clients since their clinics reopened last summer.² Dermatology practices that offer aesthetics have had a similar experience. For example, at my practice in East Texas, patients came back immediately once the quarantine orders lifted. Once considered taboo, people today think of injectables as they do about maintaining their hair or nails—it’s become a priority because it’s part of who they are. And surprisingly, despite mask culture, we also have seen a huge increase in requests for cheek and lip injections in younger patients, perhaps due to more widespread use of Snapchat filters, photo editing software,³ and the pervasive effect of influencers on Instagram and TikTok.

The Value of Evidence-Based Aesthetics

While the value of aesthetics to some may still seem only skin deep, the truth is, adding minimally invasive aesthetics to a dermatology practice not only makes good business sense but also speaks to our responsibility as physicians. Increased demand for aesthetic procedures has resulted in an ever-increasing number of beauty parlor and charlatans providing scientifically unproven aesthetic services and making unproven claims.⁴ Dermatologists aren’t traditionally trained in cosmetics, but, professionally speaking, we should be the ones doing it. Aesthetician injectors and nurse injectors can charge less than board-certified physicians for Botox or fillers, but they may not know the anatomy of the face or understand how to handle potential complications.

Dermatologists, with our extensive training and knowledge of facial anatomy, skin surgery, and photoaging, are well-positioned to safely and effectively meet the needs of a growing number of people seeking information on noninvasive cosmetic procedures. What’s more, every cosmetic appointment is an opportunity to educate patients on the latest advancements in treatment for medical conditions, such as rosacea and acne scars, as well as the importance of using a good sunscreen, basic antioxidants, and daily retinoids. As dermatologists, we not only want our patients’ volume and animation to look good, but we also want their skin to look youthful, clear, and young. Healthy, happy skin should always be our No. 1 priority.

The Business Case for Aesthetics

Over the next five years, the global medical aesthetics market is projected to reach $15.9 billion from $9.4 billion in 2020.⁵ The key factors driving the growth of this market include the increased adoption of noninvasive aesthetic procedures, rising adoption among older Americans, increasing public awareness about cosmetic procedures, the availability of technologically advanced and user-friendly products, and the increasing demand for aesthetic treatments among men.⁶

Herein lies the case for the addition of specialization in aesthetics as a supplementary source of revenue for an existing general dermatology practice or even as the sole focus of a practice. Already in 2021, we’ve seen reimbursement cuts for Medicare, changes in the valuation of management coding, and decreases for procedural codes. Aesthetics is a nice ancillary service. To some degree, we can’t control what the Centers for Medicare & Medicaid Services are going to do with reimbursement rates, but we can control what to charge for a unit of Botox.

Aesthetics can also be particularly interesting for general dermatologists who are interested in practicing cosmetic dermatology but did not have the opportunity while in residency. More than half (74 percent) of dermatology residents in 2019 planned to integrate cosmetic procedures into their future practices.⁷ However, only 36 percent felt they received adequate preparatory training. Recently and on trend, there has been an increase in didactic and clinical instruction in cosmetic procedures during residency. There are also several post-residency training courses for physicians who are interested.

Given the increased demand for services, as well as the increased opportunity for clinical instruction, now is the time for dermatologists to consider incorporating aesthetics into their practices.

Getting Started in Aesthetics

There are a lot of tips and tricks to getting started in aesthetics, but the most important factor for dermatologists to consider is how to bridge the gap between their medical practice and their cosmetic practice. The best approach is to apply your knowledge and experience as a physician to how you think about cosmetics as well.

Below is a more detailed breakdown of some basic tips to get started.

Initial Services. Easy and relatively inexpensive crossover offerings to begin in aesthetics are services like microneedling and platelet-rich plasma injections. These can be used to treat various types of scars, as well as to eliminate wrinkles and generate new collagen and skin tissue for smoother, firmer, more toned skin. Neuromodulators are also a good place to start, because these procedures for treating wrinkles, frown lines, and crow’s feet are becoming ubiquitous and don’t take a lot of time to add into your daily practice.

Laser and light-based devices are effective in treating a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair,⁸ but are a huge financial investment, costing anywhere between $85,000 to $100,000. Therefore, they’re not the most cost-effective place to start when adding aesthetics. The purchase of a laser or other light based equipment also involves careful consideration to laser specifications, training, warranty, availability of spares, and reliability of service.⁹ Lasers and light-based devices are best added once an aesthetics practice has proven profitable.

Scheduling. Scheduling is a challenge when adding aesthetics to a dermatology practice. Over the years, I’ve found that separating my schedule into blocks of clinical time versus cosmetic appointments not only helps me best manage my time, but also helps me focus. When first starting out, this approach is especially important to ensure proper time allocation. You may also consider scheduling initial cosmetic dermatology consultations at nontraditional hours via telehealth appointments.

Staff & Training. Having the right people on board is critical to the success of any practice, but especially larger practices. Baseline knowledge is important in effectively communicating your service offerings to new and existing patients. Not everyone who schedules appointments is going to be knowledgeable about cosmetic procedures when your office receives inevitable phone questions. Aesthetics is geared toward more of a retail population as opposed to a medical population, which to some degree requires a different level or type of service and interaction. Your medical assistants and front desk staff will need to know what you offer, what you’re capable of doing, and your general pricing structure.

Marketing. Take time to conduct research within your local market to ensure the prices you’ve set for your practice’s cosmetic services are competitive. You will also want to consider which line of your most recommended skincare products you will want to solicit and how to incentivize retail sales within your staff. Social media is your best friend when it comes to advertising your in-office events and specials, and is also a good way to humanize your practice and educate the public on skin-related topics.

Positive Impact

If done in the right market, with the proper level of planning and intention, the addition of aesthetics can be profitable and rewarding. For me personally, I take pride in knowing that I’ve helped enhance my patients’ quality of life by improving their appearance and also positively impacting their overall skin health.

1. Hopkins ZH, Moreno C, Secrest AM. Influence of Social Media on Cosmetic Procedure Interest. J Clin Aesthet Dermatol. 2020;13(1):28-31.

2. American Society of Plastic Surgeons. 2021. ASPS Predicts New Industry Trends Amidst COVID-19 Reopenings. [online] Available at: <https://www.plasticsurgery.org/news/press-releases/american-society-of-plastic-surgeons-predicts-new-industry-trends-amidst-covid19-reopenings> [Accessed 20 January 2021].

3. Mary Ann Liebert, Inc., publishers. 2021. Association Between The Use Of Social Media And Photograph Editing Applications, Self-Esteem, And Cosmetic Surgery Acceptance. [online] Available at: <https://www.liebertpub.com/full/doi/10.1001/jamafacial.2019.0328> [Accessed 20 January 2021].

4. Goh C. The need for evidence-based aesthetic dermatology practice. J Cutan Aesthet Surg. 2009;2(2):65-71.

5. GlobeNewswire News Room. 2021. The Global Medical Aesthetics Market Is Projected To Grow At A CAGR Of 10.9%. [online] Available at: <https://www.globenewswire.com/fr/news-release/2020/09/16/2094425/0/en/The-global-medical-aesthetics-market-is-projected-to-grow-at-a-CAGR-of-10-9.html> [Accessed 20 January 2021].

6. Medical Aesthetics Market - Global Forecast To 2025 | Marketsandmarkets. [online] Marketsandmarkets.com. Available at: <https://www.marketsandmarkets.com/Market-Reports/medical-aesthetics-market-885.html> [Accessed 20 January 2021].

7. Nielson CB, Harb JN, Motaparthi K. Education in Cosmetic Procedural Dermatology: Resident Experiences and Perceptions. J Clin Aesthet Dermatol. 2019;12(8):E70-E72.

8. Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol. 2016;9:29-40.

9. Aurangabadkar SJ, Mysore V, Ahmed ES. Buying a laser - tips and pearls. J Cutan Aesthet Surg. 2014;7(2):124-130.