PracticalDermatology

There was a time, in the early days of cosmetic dermatology, when the menu of available services was limited and neurotoxin therapy—used off-label for cosmetic indications—was considered the cosmetic gateway procedure. Dermatologists who offered the service marketed it prominently, anticipating that patients might also be interested in peels and physician-dispensed skin-care products and could be eligible for or would eventually require more intensive services like dermabrasion, laser hair removal, or even CO2 laser resurfacing.

With the popularity of non-invasive cosmetic procedures growing more year after year, the creation of “gateway” programs is on the rise. Neurotoxin therapy remains a popular source of entrée into the practice for many patients, as do dermal fillers. It’s possible to build a cosmetic patient base around these injectable services. But other options exist—and they may widen the reach of the practice marketing message.

Consider body shaping technology, which may appeal to patients across a wider age range than do aesthetic injectables. Body sculpting may also seem more “acceptable” to some men, who, it must be noted, continue to seek cosmetic services at growing rates. To attract customers, gateway programs fuel competition while tending to patient needs. The CoolSculpting by Zeltiq marketing program has been at the vanguard of this for my practice, providing adequate and effective printed advertising to be displayed throughout the waiting and reception areas of medical offices, facilitating a call to action on the part of clinic visitors. Other companies, like Allergan and Medicis, have long been advocates of similar practice support, aware of the inevitable surge in patient interest and conversion to their aesthetic procedures. Programs that support physician practices do now seem to be intermingled, as a CoolSculpting patient often tends to become a “filler” patient, commonly at the same physical time and location of such procedure, and choosing the filler that they also successfully saw in educational print at the office. This gateway effect applies multi-directionally to all the various procedures offered at my practice.

THE GATEWAY EFFECT

This gateway effect refers to the funneling of patients to specific procedures offered at a medical practice that differ from the procedure or reason for which the patient originally visited such practice. For example, a patient may have an appointment for a skin check but has considered Botox (onabotulinumtoxinA, Allergan) or Restylane (Medicis/ Valeant). Such patients appreciate a reminder that such procedure is offered at our office. We utilize waiting time as an opportunity for patients to be informed of the procedures we offer. The patient may see a looping DVD on various aesthetic procedures performed at the practice and notices informative print on such procedures.

It is important, however, that there be no breaks or loose ends in the gateway process. An intake cosmetic questionnaire is provided to all patients and is then entered into the patient’s chart or electronic medical record, with easy access by the medical provider. All positive checkpoints in these questionnaires indicate an interest on the part of the patient in a given procedure and will be discussed with the patient by the physician or aesthetic consultant during the visit. This is often done after the medical reason for attending the clinic and proper full body skin examination have been performed. This protocol has become a highly effective formula for the gateway process, manifesting in the continuously increasing growth rate of our aesthetic practice. It is important to mention that at our practice we have addressed the bi-directional approach to our gateway effect, by also exposing already established and new aesthetic patients to the multitude of medical and surgical dermatologic services that our clinic offers.

My practice is essentially comprised of two offices totaling 20 procedure rooms within one location. One part of the office is dedicated to general/medical dermatology, and the other part is a CoolSculpting Center of Excellence, where other aesthetic procedures are performed, as well. We educate patients on CoolSculpting and the rest of our aesthetic services in our medical side by providing illustrative brochures and posters in the waiting room. We also play educational CoolSculpting videos and news segments on a loop visible on various screens. Additionally, all new patients are given a cosmetic questionnaire, described above, where they may check off “CoolSculpting” or “Body Contouring” as one of the aesthetic procedures they are interested in. My staff is well versed in CoolSculpting and proactively educates patients. If patients show an interest in CoolSculpting, my staff will physically walk with them after their medical examination, from the medical side to the CoolSculpting Center of Excellence for proper consultation and evaluation. It is common to see CoolSculpting treatments be performed on that same day.

THE BENEFIT OF MARKETING

As a relatively new procedure, there is a need to raise awareness in the general public and the medical population of the availability of a treatment option for non-invasive fat removal. Many patients have a need for it and would be eager to have non-invasive fat removal but are not yet aware of CoolSculpting. Marketing outside my office fills this gap and helps educate the general population on this procedure.

More than any other procedure in my practice, CoolSculpting brings in new patients. Frequently, some new patients even travel long distances to come to our office, many as far as from the Caribbean and Central and South Americas. I market CoolSculpting in a variety of ways to attract as many patients as possible. We have an ongoing television commercial and are also the official local sponsors of the Katie Couric show in Miami. Similarly, we have a radio ad with a prominent local Spanish radio station and utilize web media, like Google AdWords. We also run a billboard located near one of the most frequented avenues, as visitors and frequent travelers drive out of Miami International Airport into the city. Lastly, we host Cool Events and Media Events to inform patients and the press and television representatives, respectively, on the process of CoolSculpting.

CoolSculpting and it's marketing program have greatly benefited my practice. The outside marketing brings in new patients and is a strong driving force for the overall growth of the office. It not only directly increases revenues for CoolSculpting, but it also funnels in new patients who are generally highly interested in other aesthetic procedures we offer. It is important to note that many of the patients that specifically come for CoolSculpting see an opportunity to address their medical dermatological concerns in our practice, receiving their complete care with us.

Over the past three years, we have experienced notable growth in our CoolSculpting Center, and it continues to expand. We currently have six CoolSculpting devices and three medical specialists dedicated exclusively to CoolSculpting. They are thoroughly trained in the procedure and are personally supervised by me. After applicator placement, the operators are not required to remain in the room for most of the procedure. Therefore, the staff and I can proceed to see other patients and deliver other aesthetic treatments while CoolSculpting is underway in a treatment suite. Lastly, this device can deliver return on investment on capital equipment in as little as 50 patients. CoolSculpting has become the number one revenue generator in our practice, followed by fillers.

THE TRANSITION

Originally, CoolSculpting was intended for treatment of very localized fat bulges. But we are pioneering now the transition to “Treatment to Transformation.” This refers to patients undergoing multiple treatments in the same area and/or multiple areas of the body to achieve the maximum desired fat reduction in such areas. As a result, this approach expands the category of the ideal non-invasive fat removal patient. At my practice, we are no longer treating only isolated bulges but maximizing results to completely sculpt a problem area. We are seeing fat reduction and sculpting results with CoolSculpting that were previously only achieved with liposuction. We are able to maintain high patient satisfaction by proper evaluation and patient selection. Currently, CoolSculpting is the only fat reduction treatment modality that we offer, being able to serve most patients’ needs. Other branded and marketed procedures like Botox and Restylane injections also have gateway effects. However, as they are more widely available and offered by more providers, their potential to draw in new patients is not as marked.

Dr. Leyda Bowes has no disclosures pertaining CoolSculpting by Zeltiq.

Leyda Elizabeth Bowes, MD, is a dermatologist in private practice and founding medical director of Bowes Dermatology Group and the CoolSculpting Center of Excellence in Miami, FL.