The Year Of The Physician

It's an exciting time in the field of aesthetics. Our armamentarium of treatment options has exploded with new injectables, energy based devices, and cosmeceuticals. Through personal and scientific collaborations, we continue to refine treatment techniques and define new standards of care. We start this first issue of 2017 by looking at the state of aesthetic medicine and the “hot” trends expected to spread from meetings and journals into private offices. At the same time, we ask the question: what is your practice resolution to make your work life more fulfilling and less stressful?

The entrance of new fillers to the US market is exciting but has also added pressure on practitioners. Physicians must find ways to understand the differences between products beyond the FDA approved indications. In the US, industry cannot educate beyond those boundaries, so physicians must spend the time and money to attend CME meetings. Stocking more products adds financial pressure by increasing the cost of disposables; the purchases are spread over more companies. Alternatively, there's the putting all eggs in one basket strategy—buy everything from one company for better prices. That doesn't work if your patients come in with brand specific requests or if you rely on industry website find-a-doc functions. And for many physicians, it's important to maintain relationships with all of pharma to avoid conflict of interest in clinical practice and research.

Madison Avenue knows that women are early adopters. Then, it takes effort to normalize procedures for men. For several years, physicians and industry have worked on ways to increase the male aesthetic market. Societal and economic pressure for men, still not as great as it is for women, is growing. Market data show the number of men seeking cosmetic surgery is rising quickly, but this is still a largely untapped segment of the population that we can target for our own practice growth. The industry has been playing catch-up in attracting the male patient base to the aesthetic market through targeted advertising and outreach. Brochures with “regular” guys are now available for each botulinum toxin. Some practices have opened separate offices or schedule “Brotox” days.

Another area of aesthetics that has become popularly discussed is genital rejuvenation. Male aesthetics has moved focus from standard aesthetic procedures to a more detailed focus on penis and scrotum appearance, with lecture titles like “Scrotox.” Women are follwing similar trends. The American Society for Aesthetic Plastic Surgery reported a 50 percent increase in the number of labiaplasty procedures performed in 2014 compared to the previous year. The accessibility of internet porn and popularity of “Brazilian” hair removal for both sexes have been cited as reasons for an expanded focus on genital cosmesis. An increasingly vocal population of post-partum and menopausal women speaking about their symptoms, and women's concerns about the safety of hormonal therapy has coincided with the approval of several new devices for noninvasive vaginal rejuvenation.

While non-invasive genital rejuvenation might seem best fit for gynecologists and urologists, these procedures have been adopted most quickly by cosmetic physicians. Dermatologists and plastic surgeons receive training in genital issues and are comfortable discussing the “non-essential,” i.e. complaints that third-party payers consider cosmetic rather than medical. Certainly with the level of surgical training involved in oculoplastic surgery and facial plastic surgery, those specialties have been able to responsibly extend their reach beyond the face also. But have the core specialists really prepared for all of the ramifications of venturing into “designer vaginas” and the like? We must change the conversation from just capturing more patients and procedures to setting standards of care. Standards must include examinations needed to rule out pre-existing medical and psychological disease and parameters to measure improvement and to protect from patients with unrealistic expectations.

New injectables, genital rejuvenation, grabbing more of the male market are all options—so are new options for resurfacing and tightening, peels and cosmeceuticals, PRP alone or bundled with other procedures, a variety of energy based devices using microneedling of various configuration, and capturing the upcoming cosmetic millennial market. The options can be overwhelming. But will expanding our office “menu” mean more patients and procedures or just dilute what we currently do well? Do we need to add to remain “current” or can our results speak for themselves?

Perhaps 2017 can be the year of making decisions based on what will make us happy to go to work every day. The doctor is generally happier when staff morale is high and patients are pleased. Will adding procedures help? Or is it the year to make adjustments to your environment, shift staff responsibilities, or improve patient outreach to allow you to do what you do now better and more easily?

Whether it's adding new procedures or attracting new patient segments, making physical or digital office renovations, renewing staff morale with training and education, opening additional offices or, conversely, narrowing your practice offerings to what you enjoy most, enhancing the physician experience is top of mind! We hope 2017 is off to a great start and is your most personally successful and fulfilling year yet!

Co-Chief Editors

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