MEDICAL SPAS and NON-SURGICAL PLASTICS

[drseanlive]

whats the deal with the MDs who are doing medical spas in addition to non-surgical plastics...like the 15 minute nose job, facelift etc...basically using fillers to 'shape' the face.

is this legit? is there money to be made or is there already a lot of competition in this area? what kind of training is needed and whats the best way to get there?

thanks

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[MOHS_01]

Medical spas have experienced huge growth both in numbers and revenue over the past five years. They are NOT a easy road to riches, however. Many have looked into them for the attractiveness of a passive income stream -- only to find that the realization of very little positive cash flow. The purpose that they do serve, however, is a patient referral stream for a cosmetic practice.

As far as the "15 minute whatever" -- don't believe the hype. There have been reports of complications with the injection of fillers into the nose for the purposes of rhinoplasty, and the "lunchtime facelift" is a joke.

 

[JaggerPlate]

Medical spas have experienced huge growth both in numbers and revenue over the past five years. They are NOT a easy road to riches, however. Many have looked into them for the attractiveness of a passive income stream -- only to find that the realization of very little positive cash flow. The purpose that they do serve, however, is a patient referral stream for a cosmetic practice.

As far as the "15 minute whatever" -- don't believe the hype. There have been reports of complications with the injection of fillers into the nose for the purposes of rhinoplasty, and the "lunchtime facelift" is a joke.

Odd. It seems like everything will just keep getting less and less invasive, and things like 'liquid face lifts' and laser medicine will get more and more popular and someone doing cosmetic dermatology could run a practice from a medical spa. Why don't these make money?? I thought the overhead would be far less than a cosmetic surgery practice??

 

[maxheadroom]

Have you been in those places? The word is SPA -- there's nothing low-overhead about them. And if you pay attention to your locale, you'll notice that several medical spas are failing on a regular basis. It might be nice to be affiliated with one to get referrals, but don't get trapped into a "medical directorship" where some nurse injects BOTOX and Restylane under your "supervision" -- when there's a problem it's your tookus on the line.

If you want to be a surgeon, be a surgeon. Keep some BOTOX and fillers around and maybe play with the lasers if you have enough volume to make the rental fee or purchase price worth it, spas are an unstable business that will detract from your practice.

 

[MOHS_01]

Have you been in those places? The word is SPA -- there's nothing low-overhead about them. And if you pay attention to your locale, you'll notice that several medical spas are failing on a regular basis. It might be nice to be affiliated with one to get referrals, but don't get trapped into a "medical directorship" where some nurse injects BOTOX and Restylane under your "supervision" -- when there's a problem it's your tookus on the line.

If you want to be a surgeon, be a surgeon. Keep some BOTOX and fillers around and maybe play with the lasers if you have enough volume to make the rental fee or purchase price worth it, spas are an unstable business that will detract from your practice.

AMEN. I have watched (OK, I laughed a little) many "spas" go belly up before they ever got off the ground.

Lasers, as a rule, are a money losing proposition for most docs.

 

[drseanlive]

then how do you explain the nytimes article about the OBGyn docs opening up a spa? what about this doc, google him: alexander rivkin...seems like doctors are flocking to this strictly for $$, interesting that you all agree that its not a good way to may $....

 

[Long Dong]

then how do you explain the nytimes article about the OBGyn docs opening up a spa? what about this doc, google him: alexander rivkin...seems like doctors are flocking to this strictly for $$, interesting that you all agree that its not a good way to may $....

There is this med spa by my house run by an obgyn, and it looks pretty happening I see the guy pulls up in his bentley gt coupe, that maybe cuz he is a good bussiness man (also ob/gyn practice where i've seen his adds for vaginal rejuv) and location (the O.C.).

I know this family medicine guy who works at the prisons to get his benefits and at night goes around to the med spas in OC doing botox, fillers and selling obagi products. I know that at one of these spas(my x-gf owns) he pulls in $3-5,000 for 3-4 hours of work and that he rotates threw 4 different spas a week, pulling this kind of money at each one. The spa books the patients for him and he splits the profits with them, he is more like an independent contracter.

 

[MOHS_01]

then how do you explain the nytimes article about the OBGyn docs opening up a spa? what about this doc, google him: alexander rivkin...seems like doctors are flocking to this strictly for $$, interesting that you all agree that its not a good way to may $....

Two issues here -- let's deal with them separately. First, regarding the OB's -- do you know how absolutely sh**** practicing OB is today? They are looking for any off ramp that they can find, and I do not blame them at all. Due to their relative desperation, they are more willing to accept higher risks and lower returns when viewed in light of the hell that is private obstetrics.

Secondly -- Dr. Rivkin would best be thought of as the exception rather than the rule. Great location and early entry into the field (2003) are advantageous.

I'm not saying that $ cannot be made through this avenue, but it would be very difficult to make $$$... and it would be even more difficult if you do not have the appropriate board certification

 

[JaggerPlate]

Have you been in those places? The word is SPA -- there's nothing low-overhead about them. And if you pay attention to your locale, you'll notice that several medical spas are failing on a regular basis. It might be nice to be affiliated with one to get referrals, but don't get trapped into a "medical directorship" where some nurse injects BOTOX and Restylane under your "supervision" -- when there's a problem it's your tookus on the line.

If you want to be a surgeon, be a surgeon. Keep some BOTOX and fillers around and maybe play with the lasers if you have enough volume to make the rental fee or purchase price worth it, spas are an unstable business that will detract from your practice.

See ... I actually haven't been to or really seen them, and I also think I'm a bit confused in the terminology. I mean, when I think of a 'spa' I think of a place where people get massages and eye brow waxes, but medical spa to me seemed like filler injections, laser medicine ... more of a dermatologist running a strictly cosmetic practice. I'm not sure which one people are referring to as going belly up (maybe both), but I can understand issues with hiring people to do procedures like botox with your name on the 'spa.'

Also, MOHS_01 ... I had no idea lasers were such a risky venture. I thought people did quite well with laser hair/tattoo removals and other cosmetic laser procedures?

 

[MOHS_01]

There is this med spa by my house run by an obgyn, and it looks pretty happening I see the guy pulls up in his bentley gt coupe, that maybe cuz he is a good bussiness man (also ob/gyn practice where i've seen his adds for vaginal rejuv) and location (the O.C.).

I know this family medicine guy who works at the prisons to get his benefits and at night goes around to the med spas in OC doing botox, fillers and selling obagi products. I know that at one of these spas(my x-gf owns) he pulls in $3-5,000 for 3-4 hours of work and that he rotates threw 4 different spas a week, pulling this kind of money at each one. The spa books the patients for him and he splits the profits with them, he is more like an independent contracter.

If the OB that you speak of is Matlock or one of his disciples, I don't doubt that healthy profits are being siphoned right out of the pockets of the hapless lambs that are the public. Warning, thought -- ACOG has taken note of this and issued a position statement last year warning of the lack of safety or efficacy data for any "cosmetic GYN" procedures. Snake oil sales has historically been rather lucrative...

This is the very reason that minimally invasive cosmetic procedures are not now, and will not be, the pathway to riches. There are very few barriers to entry into the field, which has led to more and more providers offering the services. The FP's, OB's, neuro's, even radiologists are getting in on the act, and are willing to offer the services cheaper than plastics or derm. The savvy, sophisticated, or the affluent will always seek out the best qualified for the job, so if you truly enjoy doing procedures such as this, go into an appropriate specialty.

 

[MOHS_01]

See ... I actually haven't been to or really seen them, and I also think I'm a bit confused in the terminology. I mean, when I think of a 'spa' I think of a place where people get massages and eye brow waxes, but medical spa to me seemed like filler injections, laser medicine ... more of a dermatologist running a strictly cosmetic practice. I'm not sure which one people are referring to as going belly up (maybe both), but I can understand issues with hiring people to do procedures like botox with your name on the 'spa.'

Also, MOHS_01 ... I had no idea lasers were such a risky venture. I thought people did quite well with laser hair/tattoo removals and other cosmetic laser procedures?

Significant volume needs to be realized in order to make any ROI for lasers, including hair removal. Broadly speaking, an often quoted rule of thumb is that the technological half life for a laser system is 18 months -- if you cannot recuperate your investment and make money back in that time period, you will not be profitable. Assuming a $100k laser, that is a tall order for most practices. Do not believe the propaganda from the manufacturer who will tell you "three patients per week and you will be rich" (OK, I paraphrase a bit). And don't forget the service contracts for the lasers -- they will eat you alive.

A much better model for those who would like to dabble is leasing the equipment on a per diem basis, which is commonplace.

 

[JaggerPlate]

Significant volume needs to be realized in order to make any ROI for lasers, including hair removal. Broadly speaking, an often quoted rule of thumb is that the technological half life for a laser system is 18 months -- if you cannot recuperate your investment and make money back in that time period, you will not be profitable. Assuming a $100k laser, that is a tall order for most practices. Do not believe the propaganda from the manufacturer who will tell you "three patients per week and you will be rich" (OK, I paraphrase a bit). And don't forget the service contracts for the lasers -- they will eat you alive.

A much better model for those who would like to dabble is leasing the equipment on a per diem basis, which is commonplace.

Thank you for your reply doctor. I don't post in the resident/attending boards much, but you always seem to have very insightful and helpful advice. I also like the way you explained the idea behind the people doing the most invasive procedures.

Also, just as an aside ... I heard somewhere that Dr Matlock made 12 mil in a year during the peak of his cosmetic GYN practice.

 

[drseanlive]

here is my gut feeling, please correct me if i'm off:

1)there is high demand for cosmetic procedures that are non-surgical/minimally invasive
2) there aren't many doctors doing it....even the few FP/GYNs/etc dont make up for the demand, since most of the docs wont think of this and even if they do, a significant percent will stick with what they traditionally know


but question: if you couldn't go through plastics/derm, what would be the next most legit way to try this out?

Would it make sense to do a transitional year, get liscenced...then train for a few years and become an expert in these procedures and start working? Is residency a must? how would you go about this if its something you really wanted to get into as a job??

 

[DrDre311]

here is my gut feeling, please correct me if i'm off:

1)there is high demand for cosmetic procedures that are non-surgical/minimally invasive
2) there aren't many doctors doing it....even the few FP/GYNs/etc dont make up for the demand, since most of the docs wont think of this and even if they do, a significant percent will stick with what they traditionally know


but question: if you couldn't go through plastics/derm, what would be the next most legit way to try this out?

Would it make sense to do a transitional year, get liscenced...then train for a few years and become an expert in these procedures and start working? Is residency a must? how would you go about this if its something you really wanted to get into as a job??

Get rich quick schemes abound...I personally don't know of any cosmetic training programs available to someone with only PGY1 training in any field.

You aren't the first person to have the idea of providing cosmetic procedures even though you haven't been trained in dermatology or plastic surgery. Plenty of primary care types offer Botox and the like, so it's not like this is a brand new thing and you can get in on the ground floor and make a killing. Like any business, it's hard to break in from the outside and set up a successful cosmetic practice. Your best bet is to train in plastics or derm. If you can't do that, then I suppose you could do FP and then serve as a glorified NP doing Botox and Restylane for an established cosmetic practice or medical spa (as a previous poster mentioned). Even if you're appropriately trained you would need the perfect situation to really make your idea work--long odds there.

By the way, transitional programs themselves are pretty competitive because they're populated with derm, radiology, and anesthesia categoricals--those are very competitive fields in themselves. I definitely don't think it's a good idea to do one year of postgraduate training and then strike out on your own hoping to make a career out of currently in-vogue questionable procedures (such as the so-called "lunchtime facelift") without being BC/BE in any actual field of medicine.

There's no way to predict what will be popular in aesthetics when you finish med school, let alone residency/fellowship. The bottom line for this situation is that, as MOHS said, the people with real resources will always seek out the best people to make them look pretty, which generally means being BC/BE in a field appropriately trained in cosmetics (like plastics, facial plastics, or derm).

 

[drseanlive]

every point being made is valid and interesting...

however, i think it is fair to say that any cosmetic dermatologist/plastics doc starting out will be faced with very similar hardships as lets say a gen surgeon looking to get into the cosmetic field (lasers, 15 min nose job, skin treatments)...

Its my belief that impression is everything (when it comes to business at least). I've done a significant amount of research into how the successful non-plastics/derm guys do their business and it seems that what they focus on is highlighting other credentials... while paying for prime advertising and website design...

you may find it sad, but i belief that the reality of all this isn't even about the medicine, but rather how you are going to put yourself out there to be perceived by the public.

Generally i dont think the public knows the difference between a resident and a fellow, and i surely dont think majority of them would even notice the difference between a 'cosmetic' surgeon (which I believe any doctor can call themselves) vs a plastic surgeon...

my bottom line is this...take hair transplantation for example. There are legit derm and plastics board certified docs doing this and being successful at it. At the other end of the spectrum there are D.O.'s who got their residency training at wallaby university in general sugery...of course its preferable to be the plastics/derm guy. BUT, the general surgeon from walla walla whatever has potential to be at their level, given that he markets himself correctly..he is at a similar disadvantage to the bigger guys when it comes to starting his business, but he has a lot to gain..

 

[JaggerPlate]

my bottom line is this...take hair transplantation for example. There are legit derm and plastics board certified docs doing this and being successful at it. At the other end of the spectrum there are D.O.'s who got their residency training at wallaby university in general sugery...of course its preferable to be the plastics/derm guy. BUT, the general surgeon from walla walla whatever has potential to be at their level, given that he markets himself correctly..he is at a similar disadvantage to the bigger guys when it comes to starting his business, but he has a lot to gain..

That is a completely *****ic statement. DOs practice cosmetic dermatology, plastic surgery, and cosmetic surgery the same way MDs do. If you want to make a 'trained vs non-trained' example, try using someone like yourself who wants to do 1 pgy and open a boutique lawsuit center vs fully licensed MD/DOs. Just in case you were wondering:

http://www.kirbydermatology.com/ (cosmetic dermatologist-DO)
http://www.dredween.com/ (facial plastic and cosmetic surgeon-DO)
http://www.zieringmedical.com/ (dermatologist, and probably the most successful hair transplant guy around-DO)

All board certified, licensed PHYSICIANS. Idiot.


*Note: I am not trying to comment on the validity of these physicians. All I am trying to do is show this guy that DOs aren't shady, second rate hacks like he is trying to become.

 

[drseanlive]

sorry to see that you took offense to the DO comment. I did not mean to degrade DOs, rather my point was to show that the public largely does not know what DOs are, at least not the same way they know what an MD is.

 

[JaggerPlate]

sorry to see that you took offense to the DO comment. I did not mean to degrade DOs, rather my point was to show that the public largely does not know what DOs are, at least not the same way they know what an MD is.

I don't want this thread to turn into an MD vs DO ... it is not the time or the place. I understand what you mean, the general public does have less understanding of the DO degree, and DOs are probably fairly poorly represented in aesthetic fields. However, they are definitely not the correct profession to use in your example, and are capable, in every way as an MD, to become legitimate dermatologists, plastic surgeons etc.

(Also, no harm no foul ... I'm obviously not an Osteopathic Physician, so I'm not offended, just clarifying.)

 

[drseanlive]

what i am really interested in hearing from people who are in the field is this...in the event that one is interested in breaking into this field (non-surgical cosmetic procedures) and does not go through derm/plastics what would be the residency fields that would be next most legitimate.

Would it come down to Gen surgery or IM? Lets say one were to go into Gen surgery, complete 5 years of hell, what are the options after that? Can you go and try to open a business and if it doesn't work out come back for a fellowship in something you are interested in? Or will you be pretty much screwed out of a fellowship spot if you try to pull this cosmetic gig right after residency?

Basically, i'm trying to understand how to get into this field in the most legitimate manner, however I want to be realistic in terms of what sort of timeline I want to follow (in relation to residency/fellowship) as well as what the options are realistic for residency placement as we all know that derm/plastics is far from a safe bet..

 

[San_Juan_Sun]

At the other end of the spectrum there are D.O.'s who got their residency training at wallaby university in general sugery...of course its preferable to be the plastics/derm guy. BUT, the general surgeon from walla walla whatever has potential to be at their level, given that he markets himself correctly

I'm not sure that lumping derm guys in with PRS-trained surgeons is an appropriate taxonomy.

And maybe it's just me, but why would any surgeon want a relationship with bogus medical spas anyways? It ain't about "level" bro, it's about what you can offer patients in the way of real, meaningful treatment. And last time I checked, properly trained DOs offer a complete surgical repertoire for their patients, which is something that the snakeoil medical spa guys can't do.

In any case, don't waste your time smacking around DOs. Some of us know how to use the search feature. Good luck with boards.

http://forums.studentdoctor.net/showthread.php?p=6430299#post6430299

 

[drseanlive]

not sure what your point was with that...but no one is bashing DOs. In fact my school is affiliated with a DO program and many of their students do better than the MD candidates..it wasn't a negative comment, too bad that people read it that way

 

[San_Juan_Sun]

it wasn't a negative comment, too bad that people read it that way

Too bad you typed it that way.

 

[Moravian]

what i am really interested in hearing from people who are in the field is this...in the event that one is interested in breaking into this field (non-surgical cosmetic procedures) and does not go through derm/plastics what would be the residency fields that would be next most legitimate.

From reading your posts, I would suggest that you just go into business and skip medicine. You'll make more money faster, won't have to worry about getting sued, and can still take advantage of people willing to pay for things that don't really work.

 

[Fah-Q]

Secondly -- Dr. Rivkin would best be thought of as the exception rather than the rule. Great location and early entry into the field (2003) are advantageous.

... and it would be even more difficult if you do not have the appropriate board certification

Rivkin is not board certified or board eligible in ANY field. He is a complete quack who has been featured on a few TV shows. A quick background check by the producers of these shows would have quickly revealed his past and it ain't pretty. He is exactly the type of person that gives cosmetics a bad name.

 

[DrDre311]

every point being made is valid and interesting...

however, i think it is fair to say that any cosmetic dermatologist/plastics doc starting out will be faced with very similar hardships as lets say a gen surgeon looking to get into the cosmetic field (lasers, 15 min nose job, skin treatments)...

Its my belief that impression is everything (when it comes to business at least). I've done a significant amount of research into how the successful non-plastics/derm guys do their business and it seems that what they focus on is highlighting other credentials... while paying for prime advertising and website design...

you may find it sad, but i belief that the reality of all this isn't even about the medicine, but rather how you are going to put yourself out there to be perceived by the public.

Generally i dont think the public knows the difference between a resident and a fellow, and i surely dont think majority of them would even notice the difference between a 'cosmetic' surgeon (which I believe any doctor can call themselves) vs a plastic surgeon...

my bottom line is this...take hair transplantation for example. There are legit derm and plastics board certified docs doing this and being successful at it. At the other end of the spectrum there are D.O.'s who got their residency training at wallaby university in general sugery...of course its preferable to be the plastics/derm guy. BUT, the general surgeon from walla walla whatever has potential to be at their level, given that he markets himself correctly..he is at a similar disadvantage to the bigger guys when it comes to starting his business, but he has a lot to gain..

Your basic argument is analogous to saying that because Bill Gates dropped out of college and became a successful entrepreneur, the best way to become a successful businessman must be to drop out of college--even though most highly successful businesspeople are college graduates.

I concede that anything is possible but I maintain that the best path to a viable aesthetic practice is to complete a residency in an appropriate specialty. Your best bets are plastic surgery, ENT/facial plastics, and derm.