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Dr. Brian S. , Biesman

Editor’s Note: Following is Part II in a two-part series on cosmetic dermatology. This month, we’re looking at the business side of offering laser and light therapy as more and more nontraditional providers explore this popular service line. To review last month’s clinical feature on the evolution of rejuvenation therapies, please go online to www.nashvillemedicalnews.com.


Everyone is doing it.

The justification that makes it easier for consumers to consider tweaking their appearance also acts as a draw for physicians interested in increasing service lines and revenue.

After all, this is — for the most part — a cash-based business.

Dr. Brian S. Biesman, FACS, founder of the Nashville Centre for Laser and Facial Surgery and the president-elect of the American Society for Laser Medicine and Surgeries, noted that over the past decade, the number of minimally invasive procedures has risen about 850 percent.

Statistics from the American Society for Aesthetic Plastic Surgery (ASAPS) show the number of non-surgical cosmetic procedures in 1997 as 1.126 million. By 2006, the figure had ballooned to 9.534 million, which represents 83 percent of all cosmetic procedures. In total, Americans spent just under $12.2 billion in 2006 for both surgical and non-surgical procedures.

The vast majority of those seeking help were between the ages of 19 and 64 (age group 35-50 led the way at 47 percent, the 51-64 group came in at 25 percent and the younger age bracket of 19-34 accounted for another 22 percent of procedures).

Similarly, the American Society of Plastic Surgeons (ASPS) recorded a 420 percent increase in Botox® usage in the six years since 2000. According to the ASPS, in 2006 there were 4.1 million Botox procedures performed. That same year, the society reported 9.1 million minimally invasive procedures, an 8 percent increase over 2005. (Note: there is about a 400,000 variance in reported procedures between published ASAPS and ASPS 2006 statistics.)

Based on the growing demand, core providers — physicians who trained in dermatology or plastic surgery — suddenly find their field populated by both non-core physicians and non-medical personnel.

“If you talk to laser manufacturers, they’ll tell you about 76 percent of new (clients) are non-dermatologists and non-plastic surgeons,” Biesman said.

“There’s a power play going on right now — core vs. non-core — but there is a place for the non-core … no doubt about it,” said Dr. Michael H. Gold, founder and medical director of Gold Skincare and the Laser and Rejuvenation Center.

He added that at almost any medical meeting in any specialty, it is now common to find seminars and courses on laser medicine.

Gold and Biesman often conduct training in the use of lasers and other cosmetic procedures. Both physicians, who have clinical appointments at Vanderbilt, believe there is a learning curve that is lessened by having a medical degree.

Of particular concern are spas, where procedures are performed without onsite medical supervision. Although medi-spas must have a physician of record, it isn’t unusual for the doctor to be a rare visitor to the site, leaving the work to be done by those without formal medical training.

Gold noted, “There’s an expertise level missing, especially when going to a non-physician.”

Although the growing number of spas and physician practices specializing in aesthetic dermatology means increased competition, Gold also pointed out the more players that are in the marketplace, the greater the demand for improved technology.

However, it’s the rapidly evolving technology that can actually cause problems for those looking at cosmetic dermatology as a sideline — or even primary — business.

“Machines are very expensive,” Gold stated. He added that it’s easy to spend thousands on a laser only to have a technology change necessitate purchasing new equipment before completing payments on the original machine.

And equipment isn’t the only expense to be considered.

“Botox costs have gone up to the doctor every year, but the cost to the patient has remained pretty stable,” Gold said of shrinking profit margins for the leading cosmetic procedure in the world.

Biesman added that he paid $50 for a vial of Botox Cosmetic in 1989. “On January 1, 2008, they just increased the cost to $525,” he said. Biesman added that despite this increase, he hasn’t raised his prices for the procedure in about 10 years.

However, the hope is that costs might stabilize or be positively impacted in the face of increased competition for market share as several new fillers and toxins become available in the United States over the next few years.

Skincare and makeup lines are another part of the equation that must be considered. Many physicians carry at least prescription-strength skincare lines if not full cosmetic options.

“There’s a whole business to the dispensing part of dermatology,” Gold said of offering such lines. “We do it as a service to our patients … it complements what we do … not because I’m going to retire off the profit I make on these products,” he added with a laugh.

To those considering launching a cosmetic dermatology business, Biesman said, “If you’ve done the work to learn it and become knowledgeable, that’s fine. It’s just that there are a lot of people getting into it who haven’t yet gone up that learning curve.”

To consumers, both Biesman and Gold stressed the importance of doing the homework before selecting a core, non-core or non-physician provider.

“It would behoove consumers to think about facial aesthetics in much the way they would any other specialty care,” Biesman counseled.



March 2008

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