Skin work stacks up
Skin work stacks up
October 27, 2007
By Elaine Gaston
Checking suspicious moles, removing skin cancers and treating acne and other skin conditions are traditional services one would expect to see at the dermatologist's office.
But a growing segment of what dermatologists do also includes beautifying patients with laser beams, Botox injections, wrinkle-reducing skin care techniques and skin care products.
"Dermatology is a constantly evolving specialty with new developments constantly being integrated into clinical practice," said Dr. William P. Coleman III, clinical professor of dermatology and adjunct professor of surgery at Tulane University Health Sciences Center in New Orleans. "This rich source of new procedures has led many of the dermatologists who have pioneered them to become more subspecialized."
With more dermatologists staying busy with cosmetic medicine, it would appear the gap between medical and cosmetic dermatology is widening. While some experts say the shift further exacerbates the delays that patients seeking traditional dermatology already are facing, others maintain it's a natural progression of the profession. Older dermatologists are brushing up on new technologies while newer dermatologists are coming out of medical school already trained in the latest advancements.
"This is not a splitting up of the specialty but growth from innovation," Coleman said.
Procedures on the rise
People aged 35-50 are leading the pack, making up 47 percent of consumers seeking cosmetic procedures.
According to the American Society for Aesthetic Plastic Surgery, nearly 11.5 million surgical and nonsurgical procedures were performed in the U.S. in 2006, a 446 percent increase since 1997, with the most popular procedures performed being Botox injections and liposuction.
"With baby boomers being a big part of our population and everyone living longer, people are wanting to maintain their skin more so than they ever cared before," said Dr. Roberta Sengelmann, associate professor of dermatology and otolaryngology and director of dermatologic and cosmetic surgery at the Washington University School of Medicine. "People feel good, but when they look in the mirror, they may think they don't look as good as they feel and ask what can be done."
Dr. Richard Hussey with Myrtle Beach Dermatology said cosmetic services offered in his office have been added slowly and deliberately.
"I think in general that dermatologists and plastic surgeons are less likely to jump on the latest bandwagon until the newest procedures are proven to be both effective and safe," Hussey said. "I have tried to add services for medical conditions such as rosacea and excessive hair in addition to treating photoaging."
Older dermatologists are tempted to offer more cosmetic procedures - most not covered by insurance - because patients are willing to pay and they don't have to deal with the frustration of waiting for insurance reimbursements after medical treatments. Cosmetic dermatology can be a means of supplementing a practice in light of declining reimbursements, Sengelmann said.
"If you have somebody with training out there in general dermatology, if they know how to do Botox and fillers, they know how to make up for those cuts in reimbursements," Sengelmann said. "Patients are asking for it. They may think, 'I don't love it all that much, but I know how to do it.' And the good thing is, they can get paid for it."
Access to appointments
With most local dermatology offices experiencing a six- to eight-month wait to schedule a skin or mole check, the wait for Botox is much less, mainly because physicians designate open slots just for those procedures. If patients fail to fill those slots, a dermatologist may end up releasing it and filling it with a patient seeking a medical evaluation, Sengelmann said.
"Today, a lot of new general dermatologists are saying, let's keep them open because we want these patients in our practice," Sengelmann said.
This practice can create the perception that the cosmetic part of dermatology is squeezing out the medical side, leading to a shortage of medical dermatologists.
But Coleman doesn't subscribe to that theory.
"There are many bright young dermatologists entering medical dermatology practices," Coleman said. "The medical side of dermatology has also seen incredible innovation over the last several years with numerous new therapies helping patients with a variety of skin diseases. The problem is an overall lack of all types of dermatologists."
Hussey said he's never decreased the number of general dermatology appointment slots to make room for the cosmetic part of his practice. His office is currently not taking any new patients and has a waiting list of about 100.
"I can only speak for my practice regarding access for appointments," Hussey said. "The biggest problem with getting a dermatology appointment in this area is the small number of dermatologists for the large growth in population."
The shortage isn't a result of medical students disinterested in dermatology. It's the lack of residency positions available and the government's reluctance to increase residency numbers, Coleman said.
"So there are fewer dermatologists per capita," he said. "Add to this the increased scope of practice of the specialty and you have a tremendous problem accessing dermatologists. This has spawned a number of pseudo-dermatologists with little training who attempt to practice dermatology, often with disastrous results."
Hussey said he enjoys seeing the results of the cosmetic side of his practice.
"There is satisfaction in the ability to improve a patient's quality of life with a cosmetic procedure," Hussey said. "Removing blood vessels on the face or using Botox to diminish the appearance of a permanent scowl on someone's forehead can be very important to some patients."
Becky Patrick-Johnson of Myrtle Beach, a patient of Hussey's, began treatment Thursday to treat small blood vessels that resemble pimples on her face.
"I've had this one since I was 4," Patrick-Johnson said, pointing to her cheek. "I just noticed I'm getting more and more. I'm glad there is something I can do to get rid of them."
When she learned intense pulse light therapy might work to eliminate the blemishes, she decided to ask her longtime dermatologist for treatment.
"I've been coming to him for years," she said. "My whole family comes here."
Patrick-Johnson represents those patients with established relationships with their dermatologists because of medical treatments who also trust them to perform cosmetic procedures.
"Cosmetic dermatology is attractive because the patient chooses the doctor because of his or her reputation and ability, not because they are forced to see him or her by their insurance plan," Coleman said. "This makes for a richer relationship between the dermatologist and the patient. What develops is a collaboration between them with one goal: to make the patient look and feel better about themselves. That's pretty attractive."
Top five nonsurgical cosmetic procedures
Laser hair removal
Laser skin resurfacing
11.5 million surgical and nonsurgical cosmetic procedures performed in 2006
749 percent increase in number of nonsurgical procedures performed on women since 1997
722 percent increase in number of nonsurgical procedures performed on men since 1997
$12.2 billion spent in U.S. on cosmetic procedures in 2006
Source: American Society for Aesthetic Plastic Surgery