New Year, New You? The Appeal of Aesthetic Medicine

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Aesthetic medical practices are booming throughout the United States.  While both surgical and non-surgical procedures comprise aesthetic practice, non-surgical, minimally invasive options have grown in popularity during the pandemic as consumers have recognized the value of attending to overall health and wellness, particularly as more time has been spent in front of video cameras. Aesthetic medicine appeals to providers seeking an alternative to the insurance reimbursement compensation business model and allows clinicians from a diversity of backgrounds to successfully enter the industry. This article briefly examines the most popular aesthetic procedures and the key factors providers who may be interested in expanding their current medical practice to include aesthetic treatments or opening a practice solely devoted to aesthetics should consider.

What Is Aesthetic Medicine?

Aesthetic medicine is recognized as a subspecialty of medical and surgical practice comprised of diverse health interventions, including preventative, minimally invasive, and operative procedures involving human tissues, performed by duly qualified and registered medical, dental, advanced nurse practitioners, and physician assistant providers in order to maintain, improve, or restore physical, psychological, and/or sexual wellbeing of patients, using techniques which combine both medical and aesthetic considerations for the patient. Aesthetic practices often include unlicensed assistive personnel, such as laser technicians and medical assistants, as well as highly trained aestheticians to provide a full range of services.  Unlike a practice devoted to plastic surgery, which is the process of reconstructing or repairing parts of the body by the transfer of tissue, either in the treatment of injury or for cosmetic purposes, an aesthetic practice exclusively treats otherwise well patients who wish to enhance their overall wellbeing through the utilization of either a surgical or nonsurgical cosmetic procedure. The range of current products, devices, and procedures affords clinicians the option to integrate aesthetic components into an existing medical practice if diversification is desired, rather than exclusive dedication to aesthetics.

What Are Some of the Most Popular Aesthetic Procedures?

The aesthetic medicine industry achieved greater popularity in the mid-1990s, but experienced explosive growth between 2000 and 2018. Despite the pandemic, this trend is continuing. According to the American Society of Plastic Surgeons, there were 13.3 million cosmetic minimally invasive procedures performed in 2020.[1]   American patients consume the most of this international multi-billion dollar medical subspecialty annually.  Popular surgical aesthetic procedures in the United States include liposuction, breast augmentation, rhinoplasty, abdominoplasty, and rhytidectomy. The most popular nonsurgical aesthetic procedures include neurotoxin modulator injections, including Botox, injections of hyaluronic acid, hair removal, nonsurgical fat reduction, photo rejuvenation, micro blading, dermaplaning and platelet-rich plasma treatments. During the pandemic, aesthetic providers have reported an increased focus on facial treatments.

The American Academy of Dermatology attributes the increase in cosmetic consultations, in part,  to Zoom dysmorphia, a disorder triggered by the COVID pandemic’s surge in virtual meetings.[2] Board-certified dermatologist Shadi Kourosh MD, MPH, FAAD, an assistant professor of dermatology at Harvard Medical School in Boston, director of community health in the department of dermatology at Massachusetts General Hospital and director of the center for Laser Surgery and Aesthetics at Brown Dermatology, defines “Zoom dysmorphia” as “an altered or skewed negative perception of one’s body image that results from spending extended amounts of time on video calls.”  “Zoom estimates daily meeting participants grew from approximately 10 million in December 2019 to more than 300 million in April 2020. [Internal citation omitted] Board-certified dermatologists also reported a change with this increased use of video calls: a rise in the number of patients they’re seeing with negative self-perceptions.”

In a survey of more than 100 board-certified dermatologists to determine how the shift to remote work affected patient self-perception, Dr. Kourosh found that more than 50% of dermatologists reported a rise in cosmetic consultations. “What was alarming about our research results was that 86% of dermatologists surveyed who were fielding these cosmetic concerns reported that their patients referenced video conferencing as the reason for seeking cosmetic consultation,” says Dr. Kourosh.

What are Considerations for Providers?

Whether contemplating opening a new aesthetic practice or integrating procedures into an existing practice, there a few common considerations for providers to bear in mind. 

As with any clinical service, providers’ first priority must be patient safety through demonstrated competency. The American Board of Medical Specialties (ABMS) does not yet offer Board certification in aesthetic medicine, so this area of practice is open to physicians from a variety of backgrounds. Physicians and non-physician providers may gain clinical education regarding aesthetic procedures and medical grade products, medications, and devices through formal continuing medical educational programs, as well as training offered by vendors specific to their medical devices, products, and/or medications. It is imperative that providers attain and demonstrate clinical competency to perform any procedure before performing the same on patients.  The scope of practice requirements and restrictions vary from state to state, and it is the clinician’s responsibility to ensure that his or her practice comports with the prevailing scope of practice. Therefore, it is important to confirm the applicable scope of practice of the state in which the provider practices when undertaking any didactic or clinical training. This is particularly important to remember when multiple professionals with different licenses will be training and working together. 

Providers who are interested in performing aesthetic services should fully understand and plan for the financial commitment necessary to provide the desired aesthetic service. For example, the initial investment and potential revenue generated by a practice that incorporates a medical grade laser differs significantly from the integration of injectables into an existing practice.  A clinician must account for both the initial investment and potential revenue stream inasmuch as noninvasive and surgical aesthetic procedures are completely elective and are potential significant revenue generators, but have a sliding scale of costs and potential risks.

Regulatory compliance is also a significant consideration. Clinicians are responsible for compliance with all applicable state and federal laws governing their profession, as well as the policies, guidelines, regulations, and executive orders promulgated by any entity with authority over them.  It is imperative for physicians and non-physicians to fully understand the requirements for permits, registration, recordkeeping, and/or reporting to any governmental entity. For example, is it necessary for the practice to hold a permit from the State Board of Pharmacy? Must the practice retain a permit from DHEC or the DEA?  How must the prescribing provider document the patient’s chart prior to performing a procedure or making a prescription? What are the requirements for the clinical environment in which the service will be performed? What are the supervisory/collaborative considerations that must be addressed to ensure compliance if multiple professionals are working together? Is/should the practice be licensed as a salon in order to provide some or all of the intended services?

Finally, providers should consider how the addition or integration of aesthetic services will impact their quality of life and enjoyment of practice. These services offer almost immediate gratification to patients and typically provide both great patient and provider satisfaction. This area of practice typically also affords flexible scheduling for the provider because all procedures are elective and non-emergent. Direct payment for the purely elective procedures also significantly reduces the administrative burden of the insurance billing model.  

Conclusion

The world of aesthetic medicine is inviting competent and interested providers to get involved. COVID-19 has proven that the market is ripe for even further expansion as consumers have developed a greater demand and acceptance for the offering of aesthetic services. Concern about appearance during virtual conferences and  the desire to mitigate skin conditions such as “maskne” when dealing with masks on a frequent basis have driven the demand for aesthetic services. That demand is certain to increase. Providers must maintain compliance with all applicable scope of practice requirements, prevailing standards of care, and rigorous state and federal regulatory standards to ensure patient safety, even though an aesthetic practice offers relief from the administrative burdens of either a private insurance payor or governmental payor’s policies. A new year is the opportune time for providers to evaluate whether this area of medicine syncs with their overall quality of life and practice management objectives.

[1] https://www.medestheticsmag.com/news/news/21440130/asps-releases-top-cosmetic-procedures-of-2020

[2] https://www.newswise.com/coronavirus/new-research-focuses-on-a-growing-pandemic-problem-zoom-dysmorphia/?article_id=749701