In a difficult economy, physicians need to be especially mindful of the financial constraints that confront their patients. However, that admonition—the importance of helping people who are the cornerstone of a successful medical practice—too often vanishes amid the battle between volume and quality.

For aesthetic surgeons, the value of customized care is an essential investment in professional longevity. Indeed, the current economic downturn is merely a wake-up call—a loud and echoing one, to be sure—that should capture the attention of private-practice physicians everywhere.

Considering the large number of individuals who may forego cosmetic treatment because of the bad financial environment, the only way to help these patients (and maintain a healthy business) is to offer specific solutions for specific needs.

Put another way, cosmetic surgery is not the equivalent of a cheap menu. We provide specialized treatment based on the patients we see, not insincere promotions or meaningless figures designed to drive “traffic” while compromising our sworn duty to do no harm.

This wake-up call crosses multidisciplinary and multispecialty boundaries. It covers the plastic surgeon as well as the physician who takes on a cosmetic specialty as his or her practice expands.

Patients expect us to offer advice that reflects our expertise and commitment to innovative care. If we abandon that professional mission—if we succumb to every temptation to make medicine in general and cosmetic surgery in particular another meaningless commodity—then we will have squandered the one thing we enjoy above nearly all other industries: trust.


Thankfully, there are a number of practical ways we can immediately help patients who may not have the financial resources, currently, to give the OK to more extensive (and expensive) procedures.

For example: the use of intense pulsed light (IPL) directly benefits patients with various skin disorders, including acne, excessive sun exposure, and potential carcinomas, that traditionally require less innovative (but more invasive) procedures.

Along with hydrating the skin and herbal solutions (which is an increasingly popular staple among plastic surgeons and other specialists), IPL is at the forefront of combining new technology to treat these issues.

In the same vein, Aluma, Lumenis Ltd’s “skin renewal system,” is yet another treatment I use that is at the intersection of technology and medicine. Using a radio-frequency device that gently heats the tissue in an area, thus helping the body to produce collagen, Aluma can reduce fine lines and puffiness near the eyes.

Cynosure’s TriActive treatment is one more option that works to improve tone and diminish the effect of cellulite. I use it to improve the tissue surrounding scars, since it helps with local lymph flow.

Finally, a proven treatment a physician can offer is the extremely popular Botox. Due to its efficacy and popularity, the use of Botox in aesthetic practices can often turn into a license to simply make money—at the expense of customized care. Hence, the necessity for the physician to learn about a patient’s specific need, his or her medical history, and the proper number of Botox injections to give.

See also “A Recipe for Success in 2009” by Catherine Maley, MBA, in the December 2008 issue of PSP.

I would also be remiss if I did not mention that this last point, a customized approach that calculates the exact number of injections a patient needs, is a vital aspect of good cosmetic medical care. Too many injections can harm the skin or negatively alter its appearance, while too few injections can do very little except disappoint the patient.

The use of injectables (such as Botox) and laser treatments are good examples because of their popularity and relative affordability when compared to more expensive procedures.

Physicians today have a rare opportunity to invest in themselves (and thus broaden their credibility) if they adopt a customized system of patient care.

On the other hand, if you offer a mass-merchandised, one-size-fits-all form of treatment that is neither effective nor really affordable, you degrade the profession—and it is medically wrong, to boot.

We should all recognize that economic challenges are a summons to improve care, not undermine it. Let us take that attitude in all of our endeavors.

Paulette Y. Saddler, MD, is a clinical assistant professor of family medicine at the Keck School of Medicine of the University of Southern California and was recently named a fellow of the American College of Physicians. She can be reached at (626) 405-1034.