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The presence of medical and cosmetic elements within dermatology has allowed clinicians to infuse different flavors of practice into a final product that reflects their own lifestyles and methods of practice. Whereas general dermatology was the only offering for the majority of dermatology practices even up to 25 years ago, the arena has changed significantly since then. Newer residents are graduating with the assumption that the practices they will operate will be a mixture of cosmetic and general dermatology. Additionally, there are many existing practitioners who are learning new procedures that weren't even available five years ago and adapting them to fit their method of practice. This integration of medical and cosmetic enables dermatologists to have a varied and interesting life, full of different clinical opportunities.

Additionally, while many existing practitioners believe they have an “either/or” cosmetic/medical choice in practice, the reality is that it really isn't possible anymore to be one or the other. Many dermatologists who would characterize themselves as purely medical are faced with treating scars or acne that calls for some cosmetic knowledge in the treatment plan. By the same token, dermatologists who see themselves as purely cosmetic may be presented with medical issues that must be managed for their patients. It is increasingly necessary to have a fluency and involvement with both aspects of dermatology.

In my own case, I started off with a combination of some cosmetics and cosmeceuticals introduced into a small, but expanding, medical base. Over time the medical base has continued to grow, but the cosmetic base has outpaced it in the past several years. Medical patients still constitute a relatively higher percentage than cosmetic patients, but the dollars generated from cosmetic patients dwarf those from the medical patients. Having said that, it remains very difficult to exist solely from the cosmetic revenue and continue to grow if there isn't a medical base for the practice that brings in new patients and new patients' family or friends.

Achieving Balance via Marketing

One of the most important aspects of combining the cosmetic and medical elements of dermatology is marketing. Since starting practice 20 years ago, my practice has marketed to both cosmetic and medical populations in print, radio, and, most recently, billboard advertising. We have found that print and radio advertising has been ideal in marketing a combination of these sorts of practice initiatives, including attention to topics such as neurotoxins/ fillers as well as to patients with acne, psoriasis, and other medical conditions. Radio is particularly useful for the cosmetic arena but it is also effective when applied to medical treatments. And, while we think of billboard and television as more suitable for the cosmetic part of the practice, there are certainly instances where medical conditions can be advertised effectively in the media.

As for in-house advertising, we tend to focus on both aspects of practice, and we believe that this is where the majority of our best advertising originates, both revenueand cost-wise. It goes without saying that when a patient arrives in your office, they have already “pre-qualified” you and are potentially receptive to your practice's marketing or influence. Without any significant effort, brochures and ads in the waiting room can lead to a conversation with one of these patients or one of their family or friends, laying the groundwork for an eventual consultation. It is also very important to have knowledgeable staff that is comfortable initiating or continuing the conversation. It is important, however, that your staff have the same goals and feelings about cosmetic dermatology if you wish to make it a success in your practice.

Finally, we must look at patient perception. While most dermatologists are steeped in the culture of their profession and realize the role that cosmetics play in practice, many patients are more accustomed to a dermatology world of the 1980s or 1990s, when cosmetic opportunities weren't a recognized part of a “dermatology visit.” Many patients who visit dermatologists expecting only treatment of acne or warts are today presented with a different version of dermatology. The dermatologist and the staff must be ready to prompt patients with visual or oral cues in order to communicate the new services available at the practice.

As in other professions where marked changes have occurred, it is difficult to retrain patients to understand and integrate new options. One useful technique is to imagine yourself in the role of consumer. Think critically about what it's like for a patient to enter your practice as an outsider and be exposed to the variety of procedures that form your brand. One element to remember is that the patients in a dermatology practice may be interested in cosmetic procedures, and would consider having a dermatologist perform them, even though they might never have considered going to a plastic surgeon de novo.

In my practice, approximately 25 percent of new cosmetic patients initiate their visit for a standard medical service, yet ask about cosmetic services while being seen. It is important to note also that many of these individuals may be simply coming to the office under a medical visit guise to “try the practice out” and see if it is acceptable to them for cosmetic services. This speaks to the natural advantage dermatologists have because of the multiple avenues patients may choose as the reasons for an initial contact. It is critical for dermatologists to foster good relationships with patients and engender trust, after which well-placed ad materials and an informed staff can take over the role of educating patients about potential cosmetic procedures.

An Evolving Continuum

Dermatology is an ever-evolving specialty and a unique one, in part because it brings together disparate aspects of medical care. To favor general dermatology over cosmetics or vice versa is to do our patients and ourselves a disservice. In my view, the capability and willingness to offer and perform cosmetic procedures has become a necessity for dermatologists, not only to maximize efficiency and overhead, but also to meet the demands of our modern, sophisticated patient base.

While there are realistic measures that separate most medical and cosmetic procedures (perhaps most importantly insurance reimbursement), it helps to think of our specialty more as a continuum than a black and white division. In my mind, there should be no difference in approach to a cosmetic patient, whether that patient is a child who is in your office for acne or an individual who has a wart. Whereas many dermatologists consider warts strictly medical, we should also consider that from the patient's perspective, any improvement in appearance—be it a wart removal, wrinkle treatment, or acne therapy—is a worthwhile medical procedure.

The Main Point

The main differentiating point to remember in considering medical versus cosmetic procedures is customer service. When a practice decides that it will introduce cosmetic procedures, the bar is raised when it comes to customer service and patient expectations. Certain aspects of the practice must be fine-tuned and promoted to ensure success, benefitting not only cosmetic patients but also the medical patients seeking care. In this day and age, when every practice is rated and evaluated by patients and insurance companies alike, giving better customer service is no longer an added benefit but a necessity.

It is further important to note that one of the significant advantages we have when we treat cosmetic patients is the medical background we have as dermatologists. Those who lack a close familiarity with skin don't have the insight we have into infections, burns, and other dramatic exposures. Dermatologists have some degree of comfort because they know how to navigate complicated medical and cosmetic concerns, what the ultimate expression of a disease can be, and whether a patient should or should not be treated with a cosmetic procedure or device. While this may not seem to be under the “customer service” label, it clearly is a value added proposition for our patients and ultimately translates to better care.

Many dermatologists feel that it is not the purview of our specialty to perform cosmetic procedures, whereas the opposite might be the case when it comes to understanding and dealing with complications. That's not to say that there aren't other specialties that contribute greatly to the knowledge and practice of cosmetic surgery. But when it comes to many procedures that have become widely associated with dermatology, such as toxins, fillers, lasers, and other devices, dermatologists' unique knowledge and insight offer patients innumerable opportunities to improve their skin health.

Joel Schlessinger, MD is Founder and Course Director of Cosmetic Surgery Forum. He practices in Omaha, NE. The 2012 Cosmetic Surgery Forum will be held from Nov. 29 – Dec. 1 at the Venetian/ Palazzo in Las Vegas, NV. For more information and to register, visit Contact Dr. Schlessinger at

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