Good, Better, Best?

Professional courtesy. The phrase often gets bandied about to refer to a discount on services or waiver of payment between peers, but I prefer to use it in a different manner. “Professional courtesy,” for the purpose of this article, is defined as respecting what our colleagues do for a living and how they do it.

When I trained, the groups that were proficient in and/or fought over facial aesthetics’ territory were plastic surgeons, oral and maxillofacial surgeons, and ear-nose-throat specialists (facial plastic surgeons). Surgeons within three surgical specialties were acting like children in a sandbox. When and where I trained (I know, I’m old), dermatologists and oculoplastics were not the powerhouses they are now.

Over the last 20 years, the landscape has changed in exponential proportions. First and foremost, non- or minimally-invasive procedures were introduced. This technology included neuromodulators, fillers, thread lifts, microneedling, and many others. There is also an array of devices to melt fat, freeze fat, tighten skin, remove hair, treat veins, erase brown spots, and much more.

The mere introduction of these products, techniques, and devices is not what drove the current market. Instead, it was the fact that various specialties were able to administer these products or operate these devices. In fact, many nontraditional cosmetic specialties pioneered these new technologies.

Today, the list of providers continues to expand and includes (and excuse me, if I omit your profession): plastic surgeons, facial plastic surgeons, oral and maxillofacial surgeons, dermatologists, oculoplastic and ophthalmologic surgeons, anesthesiologists, primary care physicians and family practice physicians, obstetrician/gynecologists, emergency medicine doctors, and just about any other medical or dental specialist you can think of, not to mention RNs, NPs, and PAs as “physician extenders.”

Procedures that were once “medical” may now be offered at spas, health clubs, and hair salons—especially injectables. This really irks a lot of docs. But not me; not at all.

This is America. We are a democracy and a capitalistic nation. As long as somebody is providing safe treatments with predictable outcomes and is licensed by their locality to perform these services, the patient benefits from convenience and provider selection. I’m sure that many people reading this are raising their eyebrows and shaking their heads because, of course, we have all treated complications from providers who we may not think should be offering certain procedures. Keep in mind that the people who you think shouldn’t be performing these procedures have likely seen a complication from someone in your own specialty.

The Winner Takes It All

With all these potential providers, who can decide who is good, better, or best? In aesthetic medicine and surgery, superiority comes in many forms. It may be someone who has been in practice for a long time, an early adopter who pursues new technology and procedures, or someone who is very, very good at a specific procedure.

Successful people must find a way to brag without actually bragging—let their work and reputation do the talking. Getting the word out on a given provider’s skill set was once limited to word of mouth and conventional advertising. Social media drastically changed the entire landscape and not necessarily for the better. Unfortunately, many providers will hype procedures across social media that are not evidence-based or are simply ineffective.

People can go online daily to read or to watch videos that will lead them to believe that a deep plane facelift is the only safe, effective, and lasting facelift technique. Although this is a good technique and one that I perform on select patients, it is certainly not the only safe, effective, and long-lasting technique. In terms of facelift surgery, a doctor could perform SMASplication, SMASectomy, SMAS flap and/or deep plane facelift and be very good or very bad at a given technique. Obviously, there are many ways to perform a safe facelift surgery with natural outcomes, and it is up to every provider to figure out what procedures are safe and effective in their hands.

“Dance with the one who brung you”

Exceptional practitioners are continually challenging themselves to seek better, safer, and more effective ways to perform a given technique. Progressive practitioners never stop teaching or learning. There does exist a lure to become entrapped in somebody else’s methods, hype, or promotion. A standing joke is that the most unsafe time to have surgery is right after an annual meeting where you have a lot of people on the podium talking about things that may or may not be safe and effective. When you ask them about that procedure at the next annual meeting they often say, “Oh, I quit doing that.”

Younger practitioners must develop their own skill set and find the safest treatments with natural outcomes and stick with them. Sometimes we worry too much about what the other person is doing. I’ve seen a lot of people get in trouble or have problems because they strayed from the predictable procedures and techniques that got them where they are. As my buddy Scott from Mississippi used to say, “Dance with the one who brung you.”

Expectation Management

I have a surgical practice. I do more than 100 facelifts a year. My patients expect a big bang. My dear friend is a family practice doctor down the street and may do small procedures with small outcomes, and her patients love it and love her. She tells them exactly what to expect and what not to expect. For such a small change, my patients would want a refund. The key is transparency and honesty. Never promise a dramatic result from a minimal procedure. Your patients will be happy and satisfied if your predictions meet their results. The wheels come off when people promise big results from small procedures.

With all the hype on social media and so many fake and adulterated pictures and testimonials, patient expectations often greatly exceed what many of us can deliver.

Professional courtesy, Redefined

Now back to my definition of professional courtesy. I embrace all these various specialties as long as they meet my two commandments: patient safety and natural outcomes. I send them non-surgical patients and they send me surgical patients. “Big” doctors embrace each other. They enjoy going to work, are comfortable in their own skin, are confident, busy, and don’t have time to cast negatives at competition. In fact, they don’t see colleagues as competitors; rather, they see them as other offices. They know they are winning and don’t mind other docs winning, as well.