Grow your practice by merging aesthetic specialties

As more physicians join plastic surgeons in the burgeoning market of aesthetic medicine, questions arise concerning the differences among the specialties and the training required for them. Each specialty has its unique areas of training and innovation.

By definition, aesthetic plastic surgery is the surgical subspecialty that focuses on enhancing appearance via a wide spectrum of surgical, nonsurgical, and pharmaceutical techniques. It is specifically concerned with maintaining, restoring, or enhancing normal appearance.

In today’s expanding market, aesthetic surgery is practiced by physicians in various disciplines, such as plastic surgery, facial plastic surgery, oral and maxillofacial surgery, dermatologic surgery, head and neck surgery, bariatric surgery, oculoplastic surgery, and general surgery, all of whom take different approaches to the head and body. The cross-fertilization among these disciplines has added to the physicians’ accumulated knowledge and skills. (See box on page 48.)

Patients today have a growing appreciation of the areas of surgical specialization. It is not unusual for consumers to seek out someone who they perceive is a specialist in each type of surgery they are considering. Combining certain areas of specialization under one roof may give your practice a competitive advantage in the market.

Multiple Options

Specialties can be successfully combined in many ways. For example, plastic surgeons and dermatologists can work very well in tandem. Bruce E. Katz, MD, a clinical professor of dermatology at the Mt Sinai School of Medicine and director of the Juva Skin & Laser Center MediSpa, both in New York City, sees many advantages in expanding his medical team to include a plastic surgeon.

“The fact that we have a plastic surgeon and a cosmetic surgery fellow alongside three dermatologists and one Mohs surgeon on-site offers patients every kind of cosmetic treatment available,” Katz says. “When a patient comes to see me with a sagging-skin complaint, I can offer her infrared skin tightening or a facelift by my plastic surgical colleague. Patients feel very comfortable that we can give them an honest appraisal of what they really need.”

A Logical Combination

Another very logical combination is the union of facial plastic surgeons with full-body plastic surgeons. In 1998, William Silver, MD, FACS, a board member of the American Academy of Facial Plastic and Reconstructive Surgery who practices at Premier Image Cosmetic & Laser Surgery in Atlanta, formed an alliance among two board-certified facial plastic surgeons and a board-certified plastic surgeon.

“We started this partnership to offer the patient a complete cosmetic treatment option, allowing the practice to communicate with the patients on a ‘whole-body’ concept instead of just the face,” says Silver. “The partnership has flourished and continues to offer our patients a complete cosmetic option.”

A Different Twist

Kenneth A. Arndt, MD, a clinical professor of dermatology at the Yale and Harvard medical schools and codirector of SkinCare Physicians of Chestnut Hill (Mass), offers another option. “Since the inception of our practice, we have had an oculoplastic surgeon as one of our colleagues. This has been a wonderful addition to the expertise available in our office.

“Our dermatologists can help our cosmetic patients with botulinum toxin Type A injections; soft-tissue fillers; radiofrequency skin tightening; nonablative, fractional, or full-face laser resurfacing; and treatment of their vascular or pigmented lesions,” Arndt continues, “but nothing substitutes for blepharoplasty when it is needed. She [the oculoplastic surgeon] is available for consultation about periocular aesthetic concerns in the morning and carries out procedures in our operating rooms that afternoon.”

According to Arndt, this practice has paid off for his group in many ways. “We have found this relationship to be rewarding for our office, our oculoplastic colleague, and our patients.”

Finally, William P. Werschler, MD, FAAD, an assistant clinical professor of medicine in dermatology at the Univer-sity of Washington, Seattle, has teamed up with aesthetic dentist Ken Collins, Jr, DDS, to form the highly successful Spo-kane Makeover Team. “This cooperative marketing program involves selecting candidates for a makeover that can include cosmetic or dental surgery procedures. It has allowed each of us to leverage our unique expertise to grow our individual practices in an ethical manner,” says Werschler.

Merging Mechanisms

There are several mechanisms for merging specialties. In many practices, it may be as simple as having an ongoing referral relationship with another practice in the same medical building or in the same town. In many cases, you can experiment by inviting another specialist to see patients 1 or 2 days per week in your facility to determine whether there is a good fit. It is far riskier for a specialist to immediately give up his or her office and move into another practice.

In other cases, the alliance can be made more “official” by merging practices and patient bases into one professional corporation. The merger can give each practitioner access to a much broader patient population, and it is a natural cross-marketing opportunity.

Extending the Trend

An extension of the trend of merging specialties is the emergence of practices that are partnering with allied health professionals to further enhance their menu of services and to incorporate a wellness component. A carefully coordinated program of preoperative and postoperative nutritional and fitness counseling and skin management can be introduced to help patients maintain the results of their procedures and accelerate the healing process.

As Katz explains, “We have added two nutritionists, a psychotherapist, an acu­puncturist, and a personal trainer—plus a health and wellness director to oversee their activities—in addition to our four aestheticians and two massage therapists. Developing a culture of working as a team allows us to offer a one-stop-shopping experience to all of our patients.” Many practices also offer an extensive program of educational on-site seminars as part of a holistic approach to health and surgery.

The decision to take on a partner can be a difficult and somewhat risky one, given the potential personality differences between surgeons and other medical professionals. As in any long-term professional relationship, care should be taken when choosing a partner. There is a clear advantage to merging with another well-established practitioner who has a patient base similar to your own in terms of aesthetic versus reconstructive goals, fee-for-service versus insurance-based economics, and demographics.

If you choose to work with a surgeon or other health care provider who has recently begun to practice, careful consideration should be given to whether his or her practice can grow without eroding your patient base. It is obviously practical to partner with someone who practices in your geographic area, so that merging practices will not force any current patients to travel great distances.

Another significant concern is how to manage the inevitable overlaps among specialists in terms of the division of procedures and treatments, operating-room time, staffing, telephone service, examining rooms, and office space in general. Scheduling joint procedures with another practitioner may also present certain logistical difficulties.

Not For Everyone

Traditionalists may see this trend as disturbing. Established practitioners have a pervasive territorial fear of training their competitors. But for younger surgeons who are just starting out, joining a multispecialty practice may afford certain advantages over struggling to start a solo practice in the current competitive climate.

Whether you embrace this concept or not, it is clear that the field of aesthetic medicine is experiencing growing pains, and these new developments may require an open, less restrictive approach for you to stay competitive. PSP

Wendy Lewis is an international consultant, the author of America’s Cosmetic Doctors (Castle Connolly), and the editorial director of, a medical-marketing and publishing group. She is a contributing writer for Plastic Surgery Products.