Approximately 21% of the US population will be 65 or older in 2050 up from 13% in 2010, according to a study from the Stanford Center for Longevity.1 As the population ages, attempts to thwart — or at least rejuvenate — the hands of time are gaining in popularity, and this offers dermatologists an opportunity to carve out an “anti-aging” niche.
The demand for injectable dermal fillers, neurotoxins and autologous fat, as well as radiofrequency, laser and other heat mediated treatments, is growing significantly. Minimally invasive procedures represent one of the largest gains in aesthetic anti-aging initiatives, with injectable procedures leading the way.
The American Society for Aesthetic Plastic Surgery (ASAPS) surveyed board certified dermatologists, plastic surgeons and otolaryngologists and determined that botulinum toxin (including Botox, Allergan, Inc; Dysport, Galderma Labortories, L.P. and Xeomin, Merz North America, Inc.) remained the most frequently performed non-invasive cosmetic anti-aging procedure with a 15.6% increase from 2012 to 2013.2 This was followed by hyaluronic acid filler procedures, which were up 31.5% from 2012 to 2013. Laser hair removal, microdermabrasion and photo rejuvenation were the next most popular minimally invasive cosmetic procedures. Photo rejuvenation was up 35.3% during that time period (Table).
The ASAPS survey found that in 2013, more than $2.5 billion was spent on injectables alone. In addition, nearly $1.9 billion was spent on skin rejuvenation, a fast-growing sector of the aesthetic non-surgical industry. Given that experts suggest that anti-aging initiatives offer the best results if they begin before they are actually needed, the market and projected growth potential is quite substantial.
Expanding into Anti-Aging
Leslie Baumann, MD, of Baumann Cosmetic & Research Institute in Miami, FL, knows about expanding a dermatology practice into the anti-aging market. Her practice was instrumental in performing research that helped gain FDA approval of many of the now available injectable neurotoxins and fillers, including Botox, Dysport, Voluma, Sculptra, Juvéderm and Restylane Silk, among others. “Performing trials gives us access to new products long before other doctors, and affords us the opportunity to have the most experience with them by the time they come to market,” says Dr. Baumann who has been in practice since 1997.
Staying abreast of the latest research and being proficient in the latest techniques is critical to offering your patients the best possible results, according to Dr. Baumann. “Participating in clinical trials and being published in clinical journals garners respect both from patients and peers; and making TV appearances, being quoted in magazines and having an online presence will bring in new clients,” says Dr. Baumann. But, she warns, “If you don’t deliver top-notch results, they won’t be patients for long.”
Dr. Baumann has bolstered her reputation as an anti-aging specialist through her book publications and as chief executive officer of Skin Type Solutions Franchise System, LLC, an in- office turn-key skincare retail system she created. (See Sidebar on page 2 or on page 26 of the print issue).
Holistic Anti-Aging
Dermatologist Patricia Farris, MD, too, has carved out a niche in this segment. Her Matairie, Louisiana-based practice is roughly half cosmetic and half general dermatology, and her approach to anti-aging is focused on the emerging field of nutricosmetics, which explores the role of nutrition and nutritional supplements in skin aging. She is co-chair of the American Academy of Dermatology’s (AAD) work group on complementary and alternative medicine and a member of the Academic Society for Functional Foods and Bioactive Compounds.
Her book The Sugar Detox (De Capo Press, 2013) describes a combined nutrition and skincare program designed to prevent premature aging, weight gain and health problems that are caused by excessive sugar consumption. “I use a more holistic approach for my anti-aging patients that includes educating them on nutrition and the proper use of topical skincare products and cosmeceuticals,” says Dr. Farris. She adds, “Of course I do plenty of fillers, neurotoxin and laser treatments, as well.”
Figure 1. Patricia Farris, MD, increases her profile by doing a monthly segment on a morning television news program, and by availing herself as an expert to other media outlets.
Avoid Tech Hype
Dr. Farris points out that filler and neurotoxin injections are the mainstays of a successful non-invasive anti-aging approach and cost far less in terms of overhead, than high-tech devices. “I would suggest not getting too caught up in the ‘tech-trap,’ meaning you don’t have to buy every new device that comes along. Study the literature carefully and adopt devices that can really improve your patients’ appearance and add value to your practice. Talk to other physicians about their experience. In general, devices are expensive and you have to have a pretty good patient volume to support them,” she says.
Dr. Baumann offers similar advice. “To build a reputation as any sort of expert, it’s important to focus on what you love so you can reach your maximum potential. For anti-aging, it’s important to not be swayed by hype. You’ll get more respect for saying, ‘I’m not offering XYZ treatments until I see more convincing research,’ than saying, ‘I’m so excited about having the XYZ device that I put down a deposit before the rep even came to the office.’ My advice to young clinicians is to first look at your patient base and identify what they want. Then, look at the science and select the services with the highest efficacy. It’s more important to deliver results for your patients than to brag that you have the latest product or technology,” she says.
Dr. Farris notes bells and whistles rarely trump experience. “Patients want to know that you have experience. That’s hard to market when you are first in practice, but having some post-graduate training or doing preceptorships with established physicians helps. Publish, lecture and do things that establish you as an expert in the medical community and word will get around,” she says.
One way Dr. Farris increases her profile is by doing a monthly segment on a morning television news program, and by availing herself as an expert to other media outlets. “I have always been an advocate of doing your own public relations. I don’t think you necessarily need to hire a publicist to be successful at getting attention in the press. Reach out to local newscasters if there is a new device or an interesting study in the literature. They are always looking for a source who can help them develop a story,” she explains. “I do a monthly news segment on one of our local morning television shows, and it has been well received and has been great for our practice overall,” adds Dr. Farris. “I do all the work including coming up with the ideas and bringing in products and devices to demonstrate.”
Dr. Farris is also the director of a course called Media Training and Key Messaging that is presented annually at the AAD meeting. The course aims to teach new dermatologists how to interact effectively with the press and other groups.
“It’s an excellent course and participants get on-camera experience and advice from communication experts,” explains Dr. Farris. She says this knowledge is helpful for branding one’s self in any specialty — but perhaps even more so in the anti-aging field where visual appeal is a valuable commodity.
Article continues on page 2
{{pagebreak}}
A Gratifying Niche
West Palm Beach, Florida-based dermatologist Kenneth Beer, MD, also enjoys a 50/50 split between traditional dermatology and cosmetic dermatology. He says the ratio provides the perfect balance to enable him to “treat both types of patients with a greater understanding of outcomes.”
Dr. Beer is a founding member — along with Mary Lupo, MD, and Vic Narurkar, MD — of the annual summer Cosmetic Bootcamp meeting, where the focus is on shaping the future of aesthetic medicine, which includes an emphasis on anti-aging techniques. Providing anti-aging and aesthetic treatments such as fillers, toxins, lasers, peels and sclerotherapy, among other procedures, are particularly gratifying, he says, “because they enable me to spend more time with patients because the patients — rather than the insurance companies — are controlling the interaction.”
Dr. Beer’s recommendations for forging a reputation as an anti-aging specialist are classic suggestions that serve as the foundation for a successful premium practice in any arena. “Don’t jump on the latest trend,” says Dr. Beer. “I never liked to see procedures promoted as revolutionary with little or no data, and the longer I am in the specialty and doing research, the more that I have come to rely on data to help me guide my patient care. I would advise new dermatologists or those trying to carve out a niche in anti-aging to avoid the types of ‘quick fixes’ that are around for a year and then disappear.”
Dr. Beer also stresses the importance of participating in clinical trials, publishing, teaching as much as possible and serving as a consultant to companies developing new products. “I publish several articles a year and try to teach at The Cosmetic Bootcamp. All of these efforts enable my peers to know what I am working on and ultimately some of this trickles down to new patients,” he says.
Developing relationships with mentors is also helpful to nurturing an anti-aging niche. “I think mentors are critical,” says Dr. Beer, “and I would say that dermatology and plastic surgery are blessed to have wonderful people that help along the way. I can’t cite the number of times I have called leaders in the field for help and they have always been gracious.”
For instance, he says, “Years ago when I was a resident I walked up to Pat Wexler, MD, at the AAD meeting and asked if she would teach me to inject. She immediately invited me to her office and has been graciously sharing her expert knowledge with me ever since. When I wanted to learn about lasers, I called Roy Geronemus, MD, and he invited me to his office and showed me his lasers. I also had a great deal of help learning to write for peer reviewed publications by working with David Duffy, MD.”
Dr. Beer says another crucial element of having a thriving practice with a focus on anti-aging includes having an inviting office environment. “The office environment, including staff, is critical. If you have a sloppy office or messy waiting room, what does that say about your office? If your staff radiates the attitude that they are there because they have to pay their bills or they can’t wait until Friday, you have a problem because patients and other staff sense that. They will leave to find the spa with the pretty waiting room and the nice cookies and the receptionist who greets them by name and asks about their family. Patients only care about your skill once they make it to the exam/treatment room. If you lose them before this, they will never return,” he says.
Dr. Baumann concurs regarding the importance of nurturing the doctor–patient relationship. The importance of keeping patients happy can’t be underestimated, she says. “Building patient relationships is everything, especially in today’s day and age. One bad review on Yelp or another social media outlet can stick with you for years,” she points out.
“In my practice, I have someone from my staff personally call each and every new patient 2 to 3 days after their visit to make sure they understand their skin-care prescription and post-procedure instructions. Using the skincare recommendations properly leads to better outcomes and happy patients. Happy existing patients yield new patients. When patients see improvement in their skin with their own two eyes, they’ll tell all of their friends and family, and then they’ll want to come see you, too.”
Figure 2. Leslie Baumann, MD, was instrumental in performing research that helped gain FDA approval of many of the now available injectable neurotoxins and fillers.
Figure 3. Laser skin rejuvenation with Fraxel Dual. Photo courtesy Patricia Farris, MD.
Sidebar 1:
If I Knew Then What I Know Now
Leslie Baumann, MD, Patricia Farris, MD, and Kenneth Beer, MD, tell The Dermatologist what they wish they knew earlier in their career.
Q: What do you wish someone had told you when you were starting to branch out into ancillary services, such as anti-aging?
A: Dr. Baumann: “I wish I had baseline photographs of every patient from when I started 17 years ago. That was before digital photography so it was not practical back then. I have been telling patients for 17 years to use retinoids. The ones who did use them look the same or better than 17 years ago; the ones who did not, look a decade older. If I could show these differences to patients today, I’m certain they would be more compliant with their anti-aging regimens.”
Q: What’s something that you try to impart to new dermatologists?
A: Dr. Farris: “I always tell young dermatologists that general dermatology is still our bread and butter. We need to be experts on skin, hair and nail disorders and not lose these patients to the general practitioners. When you first venture into cosmetics and anti-aging, your initial patients come from your general dermatology population.”
Q: What’s a practice pearl that you wish you knew when you were starting out?
A: Dr. Beer: “Proceed slowly and don’t spend a fortune on equipment until you are sure you like what you are doing. Buy real estate; buy the building your practice is in instead of renting — and buy double the space that you think you will need.”
Sidebar2:
Skin Retailing Made Easy
Leslie Baumann, MD, in practice in Miami, FL, created the Skin Type Solutions (STS) Franchise System LLC, an in-office turn-key skincare retail system to help dermatologists identify products to best suit their patient’s skincare needs and streamlines the in-office and online retail process. Staff training is included so adopting the system is easy for dermatologists wanting to improve their skincare retail process.
Dr. Baumann has skin-typed 300,000-plus patients, 50,000 different product SKUs and independently evaluated over 350 skincare brands. In addition, she has performed research or consulted for 55+ skincare companies. She parlayed her skincare knowledge and the success of the STS system into the publication of the consumer book, The Skin Type Solution, (Bantam Books, 2010), and 2 textbooks, Cosmetic Dermatology: Principles and Practice (McGraw Hill, 2009) and Cosmeceuticals and Cosmetic Ingredients (McGraw Hill, 2014).
“My research on skincare products allows me to have great insight into what combinations of products work best on each Baumann Skin Type. This dramatically improves patient outcomes, improves the patient/physician relationship and builds a strong referral base. Doctors using the STS Franchise System have reported increases in skincare retail profitability and decreases in skincare product return rates within weeks of beginning the STS system,” says Dr. Baumann. “I feel that any dermatologist wanting to build their practice — both general and cosmetic derms — should consider incorporating skincare retail into their business.”
Look for the next article in The Dermatologist Business Insider Series in the July Issue.
References
1. The Stanford Center on Longevity. Aging US workforce, a chartbook of demographic shifts. July 2013. https://longevity3.stanford.edu/wp-content/uploads/2013/09/The_Aging_U.S.-Workforce.pdf. Accessed February 23, 2015.
2. The American Society for Aesthetic Plastic Surgery. Cosmetic surgery national data bank statistics, 2013. https://www.surgery.org/sites/2019.the-dermatologist.com/files/Stats2013_4.pdf. Accessed February 23, 2015.
Approximately 21% of the US population will be 65 or older in 2050 up from 13% in 2010, according to a study from the Stanford Center for Longevity.1 As the population ages, attempts to thwart — or at least rejuvenate — the hands of time are gaining in popularity, and this offers dermatologists an opportunity to carve out an “anti-aging” niche.
The demand for injectable dermal fillers, neurotoxins and autologous fat, as well as radiofrequency, laser and other heat mediated treatments, is growing significantly. Minimally invasive procedures represent one of the largest gains in aesthetic anti-aging initiatives, with injectable procedures leading the way.
The American Society for Aesthetic Plastic Surgery (ASAPS) surveyed board certified dermatologists, plastic surgeons and otolaryngologists and determined that botulinum toxin (including Botox, Allergan, Inc; Dysport, Galderma Labortories, L.P. and Xeomin, Merz North America, Inc.) remained the most frequently performed non-invasive cosmetic anti-aging procedure with a 15.6% increase from 2012 to 2013.2 This was followed by hyaluronic acid filler procedures, which were up 31.5% from 2012 to 2013. Laser hair removal, microdermabrasion and photo rejuvenation were the next most popular minimally invasive cosmetic procedures. Photo rejuvenation was up 35.3% during that time period (Table).
The ASAPS survey found that in 2013, more than $2.5 billion was spent on injectables alone. In addition, nearly $1.9 billion was spent on skin rejuvenation, a fast-growing sector of the aesthetic non-surgical industry. Given that experts suggest that anti-aging initiatives offer the best results if they begin before they are actually needed, the market and projected growth potential is quite substantial.
Expanding into Anti-Aging
Leslie Baumann, MD, of Baumann Cosmetic & Research Institute in Miami, FL, knows about expanding a dermatology practice into the anti-aging market. Her practice was instrumental in performing research that helped gain FDA approval of many of the now available injectable neurotoxins and fillers, including Botox, Dysport, Voluma, Sculptra, Juvéderm and Restylane Silk, among others. “Performing trials gives us access to new products long before other doctors, and affords us the opportunity to have the most experience with them by the time they come to market,” says Dr. Baumann who has been in practice since 1997.
Staying abreast of the latest research and being proficient in the latest techniques is critical to offering your patients the best possible results, according to Dr. Baumann. “Participating in clinical trials and being published in clinical journals garners respect both from patients and peers; and making TV appearances, being quoted in magazines and having an online presence will bring in new clients,” says Dr. Baumann. But, she warns, “If you don’t deliver top-notch results, they won’t be patients for long.”
Dr. Baumann has bolstered her reputation as an anti-aging specialist through her book publications and as chief executive officer of Skin Type Solutions Franchise System, LLC, an in- office turn-key skincare retail system she created. (See Sidebar on page 2 or on page 26 of the print issue).
Holistic Anti-Aging
Dermatologist Patricia Farris, MD, too, has carved out a niche in this segment. Her Matairie, Louisiana-based practice is roughly half cosmetic and half general dermatology, and her approach to anti-aging is focused on the emerging field of nutricosmetics, which explores the role of nutrition and nutritional supplements in skin aging. She is co-chair of the American Academy of Dermatology’s (AAD) work group on complementary and alternative medicine and a member of the Academic Society for Functional Foods and Bioactive Compounds.
Her book The Sugar Detox (De Capo Press, 2013) describes a combined nutrition and skincare program designed to prevent premature aging, weight gain and health problems that are caused by excessive sugar consumption. “I use a more holistic approach for my anti-aging patients that includes educating them on nutrition and the proper use of topical skincare products and cosmeceuticals,” says Dr. Farris. She adds, “Of course I do plenty of fillers, neurotoxin and laser treatments, as well.”
Figure 1. Patricia Farris, MD, increases her profile by doing a monthly segment on a morning television news program, and by availing herself as an expert to other media outlets.
Avoid Tech Hype
Dr. Farris points out that filler and neurotoxin injections are the mainstays of a successful non-invasive anti-aging approach and cost far less in terms of overhead, than high-tech devices. “I would suggest not getting too caught up in the ‘tech-trap,’ meaning you don’t have to buy every new device that comes along. Study the literature carefully and adopt devices that can really improve your patients’ appearance and add value to your practice. Talk to other physicians about their experience. In general, devices are expensive and you have to have a pretty good patient volume to support them,” she says.
Dr. Baumann offers similar advice. “To build a reputation as any sort of expert, it’s important to focus on what you love so you can reach your maximum potential. For anti-aging, it’s important to not be swayed by hype. You’ll get more respect for saying, ‘I’m not offering XYZ treatments until I see more convincing research,’ than saying, ‘I’m so excited about having the XYZ device that I put down a deposit before the rep even came to the office.’ My advice to young clinicians is to first look at your patient base and identify what they want. Then, look at the science and select the services with the highest efficacy. It’s more important to deliver results for your patients than to brag that you have the latest product or technology,” she says.
Dr. Farris notes bells and whistles rarely trump experience. “Patients want to know that you have experience. That’s hard to market when you are first in practice, but having some post-graduate training or doing preceptorships with established physicians helps. Publish, lecture and do things that establish you as an expert in the medical community and word will get around,” she says.
One way Dr. Farris increases her profile is by doing a monthly segment on a morning television news program, and by availing herself as an expert to other media outlets. “I have always been an advocate of doing your own public relations. I don’t think you necessarily need to hire a publicist to be successful at getting attention in the press. Reach out to local newscasters if there is a new device or an interesting study in the literature. They are always looking for a source who can help them develop a story,” she explains. “I do a monthly news segment on one of our local morning television shows, and it has been well received and has been great for our practice overall,” adds Dr. Farris. “I do all the work including coming up with the ideas and bringing in products and devices to demonstrate.”
Dr. Farris is also the director of a course called Media Training and Key Messaging that is presented annually at the AAD meeting. The course aims to teach new dermatologists how to interact effectively with the press and other groups.
“It’s an excellent course and participants get on-camera experience and advice from communication experts,” explains Dr. Farris. She says this knowledge is helpful for branding one’s self in any specialty — but perhaps even more so in the anti-aging field where visual appeal is a valuable commodity.
Article continues on page 2
{{pagebreak}}
A Gratifying Niche
West Palm Beach, Florida-based dermatologist Kenneth Beer, MD, also enjoys a 50/50 split between traditional dermatology and cosmetic dermatology. He says the ratio provides the perfect balance to enable him to “treat both types of patients with a greater understanding of outcomes.”
Dr. Beer is a founding member — along with Mary Lupo, MD, and Vic Narurkar, MD — of the annual summer Cosmetic Bootcamp meeting, where the focus is on shaping the future of aesthetic medicine, which includes an emphasis on anti-aging techniques. Providing anti-aging and aesthetic treatments such as fillers, toxins, lasers, peels and sclerotherapy, among other procedures, are particularly gratifying, he says, “because they enable me to spend more time with patients because the patients — rather than the insurance companies — are controlling the interaction.”
Dr. Beer’s recommendations for forging a reputation as an anti-aging specialist are classic suggestions that serve as the foundation for a successful premium practice in any arena. “Don’t jump on the latest trend,” says Dr. Beer. “I never liked to see procedures promoted as revolutionary with little or no data, and the longer I am in the specialty and doing research, the more that I have come to rely on data to help me guide my patient care. I would advise new dermatologists or those trying to carve out a niche in anti-aging to avoid the types of ‘quick fixes’ that are around for a year and then disappear.”
Dr. Beer also stresses the importance of participating in clinical trials, publishing, teaching as much as possible and serving as a consultant to companies developing new products. “I publish several articles a year and try to teach at The Cosmetic Bootcamp. All of these efforts enable my peers to know what I am working on and ultimately some of this trickles down to new patients,” he says.
Developing relationships with mentors is also helpful to nurturing an anti-aging niche. “I think mentors are critical,” says Dr. Beer, “and I would say that dermatology and plastic surgery are blessed to have wonderful people that help along the way. I can’t cite the number of times I have called leaders in the field for help and they have always been gracious.”
For instance, he says, “Years ago when I was a resident I walked up to Pat Wexler, MD, at the AAD meeting and asked if she would teach me to inject. She immediately invited me to her office and has been graciously sharing her expert knowledge with me ever since. When I wanted to learn about lasers, I called Roy Geronemus, MD, and he invited me to his office and showed me his lasers. I also had a great deal of help learning to write for peer reviewed publications by working with David Duffy, MD.”
Dr. Beer says another crucial element of having a thriving practice with a focus on anti-aging includes having an inviting office environment. “The office environment, including staff, is critical. If you have a sloppy office or messy waiting room, what does that say about your office? If your staff radiates the attitude that they are there because they have to pay their bills or they can’t wait until Friday, you have a problem because patients and other staff sense that. They will leave to find the spa with the pretty waiting room and the nice cookies and the receptionist who greets them by name and asks about their family. Patients only care about your skill once they make it to the exam/treatment room. If you lose them before this, they will never return,” he says.
Dr. Baumann concurs regarding the importance of nurturing the doctor–patient relationship. The importance of keeping patients happy can’t be underestimated, she says. “Building patient relationships is everything, especially in today’s day and age. One bad review on Yelp or another social media outlet can stick with you for years,” she points out.
“In my practice, I have someone from my staff personally call each and every new patient 2 to 3 days after their visit to make sure they understand their skin-care prescription and post-procedure instructions. Using the skincare recommendations properly leads to better outcomes and happy patients. Happy existing patients yield new patients. When patients see improvement in their skin with their own two eyes, they’ll tell all of their friends and family, and then they’ll want to come see you, too.”
Figure 2. Leslie Baumann, MD, was instrumental in performing research that helped gain FDA approval of many of the now available injectable neurotoxins and fillers.
Figure 3. Laser skin rejuvenation with Fraxel Dual. Photo courtesy Patricia Farris, MD.
Sidebar 1:
If I Knew Then What I Know Now
Leslie Baumann, MD, Patricia Farris, MD, and Kenneth Beer, MD, tell The Dermatologist what they wish they knew earlier in their career.
Q: What do you wish someone had told you when you were starting to branch out into ancillary services, such as anti-aging?
A: Dr. Baumann: “I wish I had baseline photographs of every patient from when I started 17 years ago. That was before digital photography so it was not practical back then. I have been telling patients for 17 years to use retinoids. The ones who did use them look the same or better than 17 years ago; the ones who did not, look a decade older. If I could show these differences to patients today, I’m certain they would be more compliant with their anti-aging regimens.”
Q: What’s something that you try to impart to new dermatologists?
A: Dr. Farris: “I always tell young dermatologists that general dermatology is still our bread and butter. We need to be experts on skin, hair and nail disorders and not lose these patients to the general practitioners. When you first venture into cosmetics and anti-aging, your initial patients come from your general dermatology population.”
Q: What’s a practice pearl that you wish you knew when you were starting out?
A: Dr. Beer: “Proceed slowly and don’t spend a fortune on equipment until you are sure you like what you are doing. Buy real estate; buy the building your practice is in instead of renting — and buy double the space that you think you will need.”
Sidebar2:
Skin Retailing Made Easy
Leslie Baumann, MD, in practice in Miami, FL, created the Skin Type Solutions (STS) Franchise System LLC, an in-office turn-key skincare retail system to help dermatologists identify products to best suit their patient’s skincare needs and streamlines the in-office and online retail process. Staff training is included so adopting the system is easy for dermatologists wanting to improve their skincare retail process.
Dr. Baumann has skin-typed 300,000-plus patients, 50,000 different product SKUs and independently evaluated over 350 skincare brands. In addition, she has performed research or consulted for 55+ skincare companies. She parlayed her skincare knowledge and the success of the STS system into the publication of the consumer book, The Skin Type Solution, (Bantam Books, 2010), and 2 textbooks, Cosmetic Dermatology: Principles and Practice (McGraw Hill, 2009) and Cosmeceuticals and Cosmetic Ingredients (McGraw Hill, 2014).
“My research on skincare products allows me to have great insight into what combinations of products work best on each Baumann Skin Type. This dramatically improves patient outcomes, improves the patient/physician relationship and builds a strong referral base. Doctors using the STS Franchise System have reported increases in skincare retail profitability and decreases in skincare product return rates within weeks of beginning the STS system,” says Dr. Baumann. “I feel that any dermatologist wanting to build their practice — both general and cosmetic derms — should consider incorporating skincare retail into their business.”
Look for the next article in The Dermatologist Business Insider Series in the July Issue.
References
1. The Stanford Center on Longevity. Aging US workforce, a chartbook of demographic shifts. July 2013. https://longevity3.stanford.edu/wp-content/uploads/2013/09/The_Aging_U.S.-Workforce.pdf. Accessed February 23, 2015.
2. The American Society for Aesthetic Plastic Surgery. Cosmetic surgery national data bank statistics, 2013. https://www.surgery.org/sites/default/files/Stats2013_4.pdf. Accessed February 23, 2015.
Approximately 21% of the US population will be 65 or older in 2050 up from 13% in 2010, according to a study from the Stanford Center for Longevity.1 As the population ages, attempts to thwart — or at least rejuvenate — the hands of time are gaining in popularity, and this offers dermatologists an opportunity to carve out an “anti-aging” niche.
The demand for injectable dermal fillers, neurotoxins and autologous fat, as well as radiofrequency, laser and other heat mediated treatments, is growing significantly. Minimally invasive procedures represent one of the largest gains in aesthetic anti-aging initiatives, with injectable procedures leading the way.
The American Society for Aesthetic Plastic Surgery (ASAPS) surveyed board certified dermatologists, plastic surgeons and otolaryngologists and determined that botulinum toxin (including Botox, Allergan, Inc; Dysport, Galderma Labortories, L.P. and Xeomin, Merz North America, Inc.) remained the most frequently performed non-invasive cosmetic anti-aging procedure with a 15.6% increase from 2012 to 2013.2 This was followed by hyaluronic acid filler procedures, which were up 31.5% from 2012 to 2013. Laser hair removal, microdermabrasion and photo rejuvenation were the next most popular minimally invasive cosmetic procedures. Photo rejuvenation was up 35.3% during that time period (Table).
The ASAPS survey found that in 2013, more than $2.5 billion was spent on injectables alone. In addition, nearly $1.9 billion was spent on skin rejuvenation, a fast-growing sector of the aesthetic non-surgical industry. Given that experts suggest that anti-aging initiatives offer the best results if they begin before they are actually needed, the market and projected growth potential is quite substantial.
Expanding into Anti-Aging
Leslie Baumann, MD, of Baumann Cosmetic & Research Institute in Miami, FL, knows about expanding a dermatology practice into the anti-aging market. Her practice was instrumental in performing research that helped gain FDA approval of many of the now available injectable neurotoxins and fillers, including Botox, Dysport, Voluma, Sculptra, Juvéderm and Restylane Silk, among others. “Performing trials gives us access to new products long before other doctors, and affords us the opportunity to have the most experience with them by the time they come to market,” says Dr. Baumann who has been in practice since 1997.
Staying abreast of the latest research and being proficient in the latest techniques is critical to offering your patients the best possible results, according to Dr. Baumann. “Participating in clinical trials and being published in clinical journals garners respect both from patients and peers; and making TV appearances, being quoted in magazines and having an online presence will bring in new clients,” says Dr. Baumann. But, she warns, “If you don’t deliver top-notch results, they won’t be patients for long.”
Dr. Baumann has bolstered her reputation as an anti-aging specialist through her book publications and as chief executive officer of Skin Type Solutions Franchise System, LLC, an in- office turn-key skincare retail system she created. (See Sidebar on page 2 or on page 26 of the print issue).
Holistic Anti-Aging
Dermatologist Patricia Farris, MD, too, has carved out a niche in this segment. Her Matairie, Louisiana-based practice is roughly half cosmetic and half general dermatology, and her approach to anti-aging is focused on the emerging field of nutricosmetics, which explores the role of nutrition and nutritional supplements in skin aging. She is co-chair of the American Academy of Dermatology’s (AAD) work group on complementary and alternative medicine and a member of the Academic Society for Functional Foods and Bioactive Compounds.
Her book The Sugar Detox (De Capo Press, 2013) describes a combined nutrition and skincare program designed to prevent premature aging, weight gain and health problems that are caused by excessive sugar consumption. “I use a more holistic approach for my anti-aging patients that includes educating them on nutrition and the proper use of topical skincare products and cosmeceuticals,” says Dr. Farris. She adds, “Of course I do plenty of fillers, neurotoxin and laser treatments, as well.”
Figure 1. Patricia Farris, MD, increases her profile by doing a monthly segment on a morning television news program, and by availing herself as an expert to other media outlets.
Avoid Tech Hype
Dr. Farris points out that filler and neurotoxin injections are the mainstays of a successful non-invasive anti-aging approach and cost far less in terms of overhead, than high-tech devices. “I would suggest not getting too caught up in the ‘tech-trap,’ meaning you don’t have to buy every new device that comes along. Study the literature carefully and adopt devices that can really improve your patients’ appearance and add value to your practice. Talk to other physicians about their experience. In general, devices are expensive and you have to have a pretty good patient volume to support them,” she says.
Dr. Baumann offers similar advice. “To build a reputation as any sort of expert, it’s important to focus on what you love so you can reach your maximum potential. For anti-aging, it’s important to not be swayed by hype. You’ll get more respect for saying, ‘I’m not offering XYZ treatments until I see more convincing research,’ than saying, ‘I’m so excited about having the XYZ device that I put down a deposit before the rep even came to the office.’ My advice to young clinicians is to first look at your patient base and identify what they want. Then, look at the science and select the services with the highest efficacy. It’s more important to deliver results for your patients than to brag that you have the latest product or technology,” she says.
Dr. Farris notes bells and whistles rarely trump experience. “Patients want to know that you have experience. That’s hard to market when you are first in practice, but having some post-graduate training or doing preceptorships with established physicians helps. Publish, lecture and do things that establish you as an expert in the medical community and word will get around,” she says.
One way Dr. Farris increases her profile is by doing a monthly segment on a morning television news program, and by availing herself as an expert to other media outlets. “I have always been an advocate of doing your own public relations. I don’t think you necessarily need to hire a publicist to be successful at getting attention in the press. Reach out to local newscasters if there is a new device or an interesting study in the literature. They are always looking for a source who can help them develop a story,” she explains. “I do a monthly news segment on one of our local morning television shows, and it has been well received and has been great for our practice overall,” adds Dr. Farris. “I do all the work including coming up with the ideas and bringing in products and devices to demonstrate.”
Dr. Farris is also the director of a course called Media Training and Key Messaging that is presented annually at the AAD meeting. The course aims to teach new dermatologists how to interact effectively with the press and other groups.
“It’s an excellent course and participants get on-camera experience and advice from communication experts,” explains Dr. Farris. She says this knowledge is helpful for branding one’s self in any specialty — but perhaps even more so in the anti-aging field where visual appeal is a valuable commodity.
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A Gratifying Niche
West Palm Beach, Florida-based dermatologist Kenneth Beer, MD, also enjoys a 50/50 split between traditional dermatology and cosmetic dermatology. He says the ratio provides the perfect balance to enable him to “treat both types of patients with a greater understanding of outcomes.”
Dr. Beer is a founding member — along with Mary Lupo, MD, and Vic Narurkar, MD — of the annual summer Cosmetic Bootcamp meeting, where the focus is on shaping the future of aesthetic medicine, which includes an emphasis on anti-aging techniques. Providing anti-aging and aesthetic treatments such as fillers, toxins, lasers, peels and sclerotherapy, among other procedures, are particularly gratifying, he says, “because they enable me to spend more time with patients because the patients — rather than the insurance companies — are controlling the interaction.”
Dr. Beer’s recommendations for forging a reputation as an anti-aging specialist are classic suggestions that serve as the foundation for a successful premium practice in any arena. “Don’t jump on the latest trend,” says Dr. Beer. “I never liked to see procedures promoted as revolutionary with little or no data, and the longer I am in the specialty and doing research, the more that I have come to rely on data to help me guide my patient care. I would advise new dermatologists or those trying to carve out a niche in anti-aging to avoid the types of ‘quick fixes’ that are around for a year and then disappear.”
Dr. Beer also stresses the importance of participating in clinical trials, publishing, teaching as much as possible and serving as a consultant to companies developing new products. “I publish several articles a year and try to teach at The Cosmetic Bootcamp. All of these efforts enable my peers to know what I am working on and ultimately some of this trickles down to new patients,” he says.
Developing relationships with mentors is also helpful to nurturing an anti-aging niche. “I think mentors are critical,” says Dr. Beer, “and I would say that dermatology and plastic surgery are blessed to have wonderful people that help along the way. I can’t cite the number of times I have called leaders in the field for help and they have always been gracious.”
For instance, he says, “Years ago when I was a resident I walked up to Pat Wexler, MD, at the AAD meeting and asked if she would teach me to inject. She immediately invited me to her office and has been graciously sharing her expert knowledge with me ever since. When I wanted to learn about lasers, I called Roy Geronemus, MD, and he invited me to his office and showed me his lasers. I also had a great deal of help learning to write for peer reviewed publications by working with David Duffy, MD.”
Dr. Beer says another crucial element of having a thriving practice with a focus on anti-aging includes having an inviting office environment. “The office environment, including staff, is critical. If you have a sloppy office or messy waiting room, what does that say about your office? If your staff radiates the attitude that they are there because they have to pay their bills or they can’t wait until Friday, you have a problem because patients and other staff sense that. They will leave to find the spa with the pretty waiting room and the nice cookies and the receptionist who greets them by name and asks about their family. Patients only care about your skill once they make it to the exam/treatment room. If you lose them before this, they will never return,” he says.
Dr. Baumann concurs regarding the importance of nurturing the doctor–patient relationship. The importance of keeping patients happy can’t be underestimated, she says. “Building patient relationships is everything, especially in today’s day and age. One bad review on Yelp or another social media outlet can stick with you for years,” she points out.
“In my practice, I have someone from my staff personally call each and every new patient 2 to 3 days after their visit to make sure they understand their skin-care prescription and post-procedure instructions. Using the skincare recommendations properly leads to better outcomes and happy patients. Happy existing patients yield new patients. When patients see improvement in their skin with their own two eyes, they’ll tell all of their friends and family, and then they’ll want to come see you, too.”
Figure 2. Leslie Baumann, MD, was instrumental in performing research that helped gain FDA approval of many of the now available injectable neurotoxins and fillers.
Figure 3. Laser skin rejuvenation with Fraxel Dual. Photo courtesy Patricia Farris, MD.
Sidebar 1:
If I Knew Then What I Know Now
Leslie Baumann, MD, Patricia Farris, MD, and Kenneth Beer, MD, tell The Dermatologist what they wish they knew earlier in their career.
Q: What do you wish someone had told you when you were starting to branch out into ancillary services, such as anti-aging?
A: Dr. Baumann: “I wish I had baseline photographs of every patient from when I started 17 years ago. That was before digital photography so it was not practical back then. I have been telling patients for 17 years to use retinoids. The ones who did use them look the same or better than 17 years ago; the ones who did not, look a decade older. If I could show these differences to patients today, I’m certain they would be more compliant with their anti-aging regimens.”
Q: What’s something that you try to impart to new dermatologists?
A: Dr. Farris: “I always tell young dermatologists that general dermatology is still our bread and butter. We need to be experts on skin, hair and nail disorders and not lose these patients to the general practitioners. When you first venture into cosmetics and anti-aging, your initial patients come from your general dermatology population.”
Q: What’s a practice pearl that you wish you knew when you were starting out?
A: Dr. Beer: “Proceed slowly and don’t spend a fortune on equipment until you are sure you like what you are doing. Buy real estate; buy the building your practice is in instead of renting — and buy double the space that you think you will need.”
Sidebar2:
Skin Retailing Made Easy
Leslie Baumann, MD, in practice in Miami, FL, created the Skin Type Solutions (STS) Franchise System LLC, an in-office turn-key skincare retail system to help dermatologists identify products to best suit their patient’s skincare needs and streamlines the in-office and online retail process. Staff training is included so adopting the system is easy for dermatologists wanting to improve their skincare retail process.
Dr. Baumann has skin-typed 300,000-plus patients, 50,000 different product SKUs and independently evaluated over 350 skincare brands. In addition, she has performed research or consulted for 55+ skincare companies. She parlayed her skincare knowledge and the success of the STS system into the publication of the consumer book, The Skin Type Solution, (Bantam Books, 2010), and 2 textbooks, Cosmetic Dermatology: Principles and Practice (McGraw Hill, 2009) and Cosmeceuticals and Cosmetic Ingredients (McGraw Hill, 2014).
“My research on skincare products allows me to have great insight into what combinations of products work best on each Baumann Skin Type. This dramatically improves patient outcomes, improves the patient/physician relationship and builds a strong referral base. Doctors using the STS Franchise System have reported increases in skincare retail profitability and decreases in skincare product return rates within weeks of beginning the STS system,” says Dr. Baumann. “I feel that any dermatologist wanting to build their practice — both general and cosmetic derms — should consider incorporating skincare retail into their business.”
Look for the next article in The Dermatologist Business Insider Series in the July Issue.
References
1. The Stanford Center on Longevity. Aging US workforce, a chartbook of demographic shifts. July 2013. https://longevity3.stanford.edu/wp-content/uploads/2013/09/The_Aging_U.S.-Workforce.pdf. Accessed February 23, 2015.
2. The American Society for Aesthetic Plastic Surgery. Cosmetic surgery national data bank statistics, 2013. https://www.surgery.org/sites/default/files/Stats2013_4.pdf. Accessed February 23, 2015.
