CHICAGO Cosmetic dermatology is a rapidly moving and rewarding area of dermatology for those with the right mind set, Gerald N. Bock, M.D., said at the American Academy of Dermatology's Academy 2005 meeting.
An elective procedures practice offers the gratification of learning new procedures, recognition as having specific expertise, and less stress as a result of upfront payments and fewer insurance hassles. Staff can be used to amplify income, and fewer patients can generate the same or greater income, he said.
"We're in the golden age of minimally invasive procedures," reported Dr. Bock.
That being said, a cosmetic practice is not for everyone.
"If you don't enjoy working with these patients, who can sometimes be more demanding, don't do it," he said. "If your sole motivation is financial gain, don't do it. This will lead you to make bad decisions. And if you just don't have the flexibility or want to learn new things or take risks, this is not for you."
Dr. Bock acknowledged that his views are colored by the fact that he established a private elective procedures practice in the unlikely Central Valley location of Stockton, Calif., a conservative agricultural community far from the aesthetically obsessed hills of Hollywood. He offered the following tips from his experiences:
▸ Set realistic expectations. It's best to underpromise and overdeliver on your services. Have a humble attitude and offer great service. "You really want to be Wal-Mart with Nordstrom practices," Dr. Bock said. Put everything in writing to avoid misunderstandings. Explain that retreatment may be necessary and failures can occur. Consent forms should list the worst-case scenario for each procedure. Dr. Bock's Botox disclosures note that death can occur.
▸ Follow-up and photographs are essential. New patients should be seen 23 weeks after their first treatment to make sure they're satisfied or to offer them additional treatments if the result is less than satisfactory. Photograph all patients, every time. Photographs improve patient satisfaction and can resolve issues that may arise later. One patient complained of eyelid ptosis from her Botox injections until she was shown pretreatment photographs that helped her to realize the ptosis was there beforehand.
▸ Proper positioning is key. Pricing your services below what people expect is one way to exceed their expectations. Start out with very reasonable pricing. You can always raise your prices later. At lower prices, patients will want more frequent and extensive treatments, leading to better results and earlier retreatment. You'll get bigger and better faster, and this may intimidate potential competitors. "Just because you're better doesn't mean people will pay more for your services," he explained. "I've had patients in the past who've had their Botox done by the plastic surgeon's nurse, even though they know I was doing a better job."
▸ Little details are important. Dr. Bock strongly recommends using Air-Tite SteriJect 31-gauge needles for Botox injections. "Everybody tells us that our Botox injections are significantly less painful than injections they get elsewhere, and that's because of these needles," he said. Consider using vibration anesthesia, a technique developed by dermatologist Kevin Smith (Dermatol. Online J. Oct 15, 2004;10:1) to reduce discomfort during dermatologic procedures, particularly for needle-phobic patients.
▸ Consider used equipment. There are a lot of good machines available if you're willing to do the research. One source is the Aesthetic Buyers Guide (www.miinews.com
▸ Keep up your training. Botox, microdermabrasion, and hair removal generate the greatest revenue in Dr. Bock's practice. But patients will demand what they can't get elsewhere. Dr. Bock gained an edge, albeit temporary, by becoming the only practice in his area to offer soft tissue augmentation with Sculptra.