Board forum: What’s Next for Aesthetic Practice?

What do you predict for your practice in 2021, as the COVID-19 pandemic persists?

John J. Martin, Jr., MD: We were closed completely for about eight weeks early in the pandemic, since there were no elective procedures allowed in our state. Since we re-opened, patients have started to return, with numbers building each month so that we are pretty much back to normal. There are still some patients quite worried about COVID, and they are coming less frequently. For others, this is a great time to do something surgically as they may be working from home so won’t see co-workers as they heal. In addition, a mask will hide any bruising or swelling that they might have.

There is a lot of talk about the Zoom effect. For the first time we are seeing our own faces at Zoom meetings, which can be a bit frightening. Never thought my neck looked that bad! Also, with masks on, patients are noticing their eye area more as this is all they are seeing in the mirror.

With a vaccine hopefully on the horizon, I hope that we can go back to some semblance of normalcy in 2021! I especially miss traveling and hope we can begin to do that again soon without fear of infection.

Todd Schlesinger, MD: Our economic forecasts turn positive in Q3 and Q4 of 2021. We are looking into a concerning time as winter approaches and people are spending more time indoors. It will be harder to maintain physical distancing, and refreshing outdoor activities will be limited. Our patients seem to have adjusted to the new order and have for the most part been willing to comply with our pandemic protocols. We hope to see an influx of pent-up demand as Americans begin to spend the more than $2 trillion they have amassed due to the economic slowdown. We see a bright 2021 in the latter part of the year.

Steven Pearlman, MD: I do not foresee a lot of change right now. Patients are spending a lot of time on Zoom and looking in the mirror at home. They want to look and feel better about themselves even though they are not (or should not be) going out. The announcement of a vaccine for which approval might be pending soon will not change things for at least the first half of 2021, due to the time it will take to get enough people vaccinated to have reasonable community immunity. If we continue to maintain extremely careful safety protocols in our practices and make that clear, patients will still come in.

Joe Niamtu, III, DMD: Like most people I was extremely worried about the effect of the pandemic on my business. We were furloughed for five weeks, so there was zero income. Much to my surprise, we are busier than we have ever been, and I attribute that to numerous reasons.

1. People are seeing the fragility of life and want to make the best of their life and appearance while they can.

2. People are working from home; there’s nowhere to go. They can’t go on their vacation or their cruise or their high school reunion and they have expendable income.

3. Everybody is covering their face with a mask so this is a good time for recovery.

4. People are stuck at home looking at their devices for FaceTime and Zoom calls and getting a good look of things they don’t like to see. For all these reasons, people are deciding to invest any extra money that they may have in themselves.

Flora Levin, MD: As long as the state does not shut us down and people continue to work from home, I think we will continue to see demand for surgical and non-surgical procedures that require downtime.

Cheryl Burgess, MD: I am hopeful for a COVID-19 effective vaccine. I predict my medical and cosmetic dermatology practice will overcome the current modified method of practice. However, I will maintain a few protocols for my standard operating procedure, such as HEPA filters in my examination rooms and reception area and mouthwash swish when performing procedures on the face. I see an increase in facial procedures, especially for my established patients who feel they need to make up their maintenance treatment plans. I see a surge in cosmetic inquiries and telehealth cosmetic consultations.

Michael Somenek, MD: I think as the COVID-19 pandemic persists, we are going to continue to see people working from home. That also means many more Zoom and virtual platforms will continue to be used and people are going to be staring at themselves even more. I have seen a surge of people who are bothered by their excess neck skin or fat in the neck, which has led to an increase in procedures related to this (necklift and/or submental liposuction).

Aside from COVID-19, what trends or products do you think will most influence aesthetic practice in 2021?

Dr. Schlesinger: 2021 might turn out to be a transitional year. People will gravitate to home-care products and devices that they can use in the comfort of their safe place. There will most likely be an entrenchment over the holidays where people may react well to pre-purchasing cosmetic services, such as body contouring, dermal fillers, neuromodulators, and laser services, only to receive the treatments later in the spring or summer. This is a good time to plan your online marketing to take advantage of all that pending demand by keeping your customers/clients/patients engaged with your practice. Writing blogs or articles for consumption by your base might be a good way to stay in front of them.

Dr. Martin: There seem to be a few fillers and toxins that will be released in the future. We also continue to see new energy devices, but without having any in person meetings, it’s harder to get to know much about these. As a surgeon, that should continue on as before.

Dr. Pearlman: Advances in non-surgical procedures and devices will continue to grow as they have over the past few years. Non-surgical facial and skin tightening devices are constantly being improved. The number of fillers and soon, neurotoxins, is expanding. This gives us more choices and more specific fillers that can be used for various depths and areas of treatment that will look more and more natural.

Dr. Niamtu: I think that there will be a continued influx of new injectable products with fillers and neuromodulators. I have primarily a surgical practice so my procedures may vary seasonally but they do not vary technologically.

Dr. Burgess: Non-invasive procedures such as skin tightening and a younger age entry level, seeking flawless skin and cosmetic facial shaping.

Dr. Somenek: The “tech neck” trend is probably still going to continue given the current situation of an increasing usage of smartphones and devices where people are tilting their head downward and increasing the number of lines in their neck. Volume replacement with fillers and wrinkle reduction with neuromodulators are going to continue to thrive in this environment.

Dr. Levin: Trend towards more natural and long-lasting results, especially for areas that seem more problematic on Zoom: eyes, necks.

What energy-based devices, procedures, or indications will grow most over the next five years?

Dr. Pearlman: Social media filters aside, a flawless complexion seems highly sought after by patients in every demographic. Energy-based microneedling devices are continuously improving and changing the landscape of skin tightening and facial maintenance. Couple this with improved lasers that address sun damage and pigmentation and that require less and less downtime, we have more tools than ever to achieve non-invasive facial rejuvenation.

Dr. Schlesinger: For energy-based devices, we may see continued improvement in the efficacy of RF-based devices for body contouring. We may finally see better results with cellulite, but that remains to be seen. “Minimally invasive” will be the key, as patients seek ways to get facial lifting without going under the knife.

Dr. Martin: I think that microneedling with RF and RF alone will continue to grow. The results with these can be good, and can be used on most skin types. Combination lasers will also be more popular to get improved results.

Dr. Niamtu: Since my practice is almost 100 perent surgical, these energy devices are irrelevant. I have tried some of them and have remained unimpressed. It is also very common that people come into my office very frustrated after having spent thousands of dollars on devices to reduce fat and tighten skin, only to see little or no difference. They lament that they should have done the facelift in the first place. I don’t condemn these new technologies but think they are a niche product that may be suitable for some doctors and a select group of patients. I have a surgical practice; I do more than 100 facelifts a year and my patients expect a big bang.

Dr. Burgess: Skin tightening in all age groups and younger patients and an emphasis on complexion blending devices especially for pigment and dyschromia. The 650nm LED red light devices are becoming more popular to perform anti-aging treatments at home.

Dr. Somenek: Non-invasive body contouring. As the technology continues to improve and we start to see better results with muscle toning and fat reduction, we are going to see an increased interest in these. A popular treatment is combining the two technologies in a single treatment to give a more comprehensive approach to the treated area on the body. That combination has the ability to change the architecture and overall appearance greater than any single modality nonsurgical treatment.

What do you foresee as the greatest opportunities and threats terms of practice management and growth?

Dr. Burgess: The greatest opportunities of growth of my practice will be in telehealth as the dermatology expert (my slogan: Leave it to the Experts), marketing on virtual consultations, and social media. The greatest threats are still non-expert health professional and personnel reducing the market value of cosmetic procedures to make up for lost time and income. Influencers are now “experts” in the eyes of social media. They do not necessarily align themselves with the proper experts or science.

Dr. Niamtu: Over the past 20 years I have had multiple corporate groups that wanted to buy my practice and for me to work for them. I’ve had several friends that have done this only to have their world collapse and end up working for someone else making less money, having to answer to a corporate entity, and only getting stock in exchange for the great practice that they had. The main reason that I went into this type of profession was to be my own boss and cast my own destiny and direction. I love doing what I do and I love being in charge and the captain of the ship. I am responsible for all successes and failures. For people that have busy and international practices, their job is their life, but it is a labor of love. I think it is very sad that the independent practitioner model is collapsing. I do feel however, that there will always be room for a competent hardworking practitioner who knows how to provide safe treatment with predictable outcomes.

Dr. Martin: It is getting tougher for doctors to set up on their own. Group practice can be a good option if you find the right mix or people, which can be difficult. Private equity is definitely trying to buy up practices. But this can lead to a miserable experience for everyone involved. If you can do it on your own, and don’t mind investing in multiple energy platforms, especially for the non-surgeons, then it is worth it!

Dr. Schlesinger: Growth is likely to be most effective when it is slow and steady. I see a return to traditional values of practice ownership, but we will still see growth in private equity influence in the aesthetic and medical dermatology markets. The private equity-based and large group practices will do well if they have a good business model and efficient operations, and if they treat physicians well. It is very important that physicians who choose to join or be acquired by larger organizations play a role in the management and decision making as well as in organized medicine. The greatest threats are likely regulatory, so having a voice is mission critical.

Dr. Pearlman: The mantra of quality over quantity applies to the aesthetic community. Each practitioner needs to decide if they want to be recognized as prioritizing getting the best results for their patients or are more about volume and speed. There will be growing competition from med-spas, non-core physician injectors and non-physician injectors. Many of these individuals are actually excellent injectors and have spent a lot of time taking advanced courses with anatomotic dissections and lectures from some of the most highly regarded teachers.

Dr. Somenek: As a facial plastic surgeon in private practice, I don’t see private equity or any multi-specialty practice in my future. However, commoditization of the procedures and treatments that I perform is always going to be a threat. All it takes is one physician in an area to price a treatment markedly lower than their competitors to create the optics of commoditization. However, the best way to manage this in my opinion is to stay true to the big picture, which is your skill, expertise, and overall experience that you provide the patient, which validates the prices that are charged. I think a great opportunity for our practices right now isthe ability to adapt to the current pandemic, adopting the most current standards for safety that will inspire confidence in your business and overall brand.